CPT Code 99214 is commonly used for billing office or outpatient visits involving established patients with moderate to high complexity in medical decision-making. To meet the criteria for this level of Evaluation and Management (E/M) service, proper documentation is critical. It requires a detailed history, detailed examination, and medical decision-making of moderate to high complexity. […]
Coders are the backbone of an organization’s fiscal health. Timely coding contributes to timely hospital revenue and cash flow, both of which are essential for a hospital to function. However, coders must be willing to look beyond their traditional roles and examine how they can help ensure the continued financial viability and financial success of […]
Reimbursement analysis provides an accurate picture of the reimbursement environment, which is important to ensure your practice will be able to provide new, innovative services. A comprehensive reimbursement analysis should be conducted with adequate lead time to include an in-depth understanding of payer-mix, the delivery cost of the new service, and the anticipated reimbursement by […]
According to some sources, patients are now the third-largest payer group in the US behind Medicare and Medicaid. So, now is not the time to let those amounts due slide! One of the best ways to capture those amounts due is by avoiding surprises on the part of the patient by letting them know right […]
Non-covered services do not require an ABN since the services are never covered under Medicare. While not required, the ABN provides an opportunity to communicate with the patient that Medicare does not cover the service and the patient will be responsible for paying for the service. Pre-emptive communication through a voluntary ABN can prevent negative […]
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 Regular audits can reveal inaccuracy issues, such as outdated codes or even fraudulent billing.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 […]
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