The stakes are high. Coding drives revenue. Coding compliantly is demanded of all practices. Physician compensation is often determined by the RVUs associated with the CPT code that is submitted on the claim form. Health systems and hospitals want to ensure that services submitted under the group NPI are accurate and represent what was done […]
Accurate medical coding plays an essential role in healthcare information management and overall quality of care. Medical coding audits, both internal and external, ensure that healthcare organizations have the proper policies and procedures in place to achieve quality medical coding. Regular audits can reveal inaccuracy issues, such as outdated codes or even fraudulent billing. These […]
A great deal of variation exists in the relationships between the pharmacist and the different types of insurance carriers, including Medicare, Medicaid, third-party payers, and managed care organizations. The Centers for Medicare and Medicaid Services (CMS), which administers Medicare and Medicaid payments for services, and the federal government are usually less flexible in dealing with […]
Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream for use as your body’s main source of energy. Diabetes is a condition in which blood sugar levels are too high. If you have type 1 or type 2 diabetes, it is very important to keep […]
The Medicare Summary Notice (MSN) is a summary of health care services and items patients have received during the previous three months. MSN is not a bill. This document is intended to help patients remember the physicians, specialties, supplies, and services involved in their care. The contractor that processes claims for Medicare will send the […]
Medical Decision Making specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition. Medical necessity determines whether the service will get reimbursed. Problems arise when MDM and medical necessity are used interchangeably, or when practices and payers […]
An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Types of APMs APMs: Meet the statutory definition of an APM. MIPS eligible clinicians participating in an APM are also subject […]
Over time, diabetes can affect any part of your body. The good news is that you can prevent or delay many health complications by taking good care of yourself. Keeping your blood sugar within the target range acceptable to you and your doctor will help you to fight complications. Some common Preventing Diabetic Complications problems […]
Gestational diabetes is diabetes that a woman can develop during pregnancy. When you have diabetes, your body cannot use the sugars and starches (carbohydrates) it takes in as food to make energy. As a result, your body collects extra sugar in your blood. We don’t know all the causes of gestational diabetes. Some—but not all—women […]
Type 2 diabetes, the more common type, occurs when your body does not make or use insulin well. Insulin is a hormone that helps glucose get into your cells to give them energy, and without it, too much glucose stays in your blood. Over time, high blood glucose can lead to serious problems with your […]
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