Receiving Medicare Reimbursements with Modifier AT

Need for Active Treatment (AT) Modifier The Centers for Medicare & Medicaid Services (CMS) developed the Active Treatment (AT) modifier to define the difference between active treatment and maintenance treatment. Medicare only pays for active/corrective treatment to correct acute or chronic subluxation. Medicare never pays for maintenance therapy. In 2018, the Medicare Fee-for-Service program reported 41 […]

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When Selling Your Practice, How to come up with a Profitable Formula?

It’s Hard to Sell Your Practice Selling a healthcare practice could be difficult a process. Key challenges in selling your practice include finding the right buyer, wading through legal and financial complications, and handling clinical matters. Coupled with a lack of knowledge about the process, some healthcare providers can be discouraged from selling their practice […]

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Guidelines for Selection of Time-based E/M Codes

Appropriate level of Evaluation and Management (E/M) services are based on Medical Decision Making (MDM) and time for services performed. In our previous article, we has a detailed discussion on how Medical Decision Making (MDM) affects E/M code selection and other factors involved. In this article, we will be focussing on guidelines for the selection […]

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MPFS Strengthening Behavioral Health Billing for 2023

CY 2023 Medicare Physician Fee Schedule (MPFS) The Centers for Medicare and Medicaid Services (CMS) on Nov. 1, 2022, released the final 2023 Medicare Physician Fee Schedule (MPFS), addressing Medicare payment and quality provisions in the coming year. The U.S. Department of Health and Human Services (HHS) through its Centers for Medicare & Medicaid Services […]

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Understand Split OB GYN Billing to Avoid Duplicate Billing

Challenges of OB GYN Billing Coding and billing for maternity obstetrical care are quite a bit different from the rest of the medical specialties. Maternity care services typically include antepartum care, delivery services, as well as postpartum care. Depending on the patient’s circumstances and insurance carrier, the provider can either, submit all rendered services for […]

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Critical Care Service Rule: Update for Surgery Billing

Defining Critical Care Under CY 2022 Medicare physician fee schedule final rule, effective from January 1, 2022, critical care services can be billed as split/shared services. Before discussing the crucial care service rule, let’s define critical care services: the direct delivery by the physician or other QHP of medical care for a critically ill/ injured […]

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Why are Physicians Prone to Merging their Practices?

Challenges of Running Solo Practice If you are a solo healthcare provider or own a small medical practice, you might sometime feel the pressure of having to do everything on your own and struggling to provide optimal patient care. Running a healthcare practice offers unique challenges like administrative and insurance tasks, government and insurance regulations, […]

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Documenting Medical Necessity for Pain Management Services

Claim Denials Due to Poor Documentation Pain management billing is been regulated by various agencies like the federal government, medical boards, state government as well as many other regulatory agents. While billing for pain management, physicians follow applicable billing guidelines and payer-specific policies to ensure accurate insurance reimbursement. Still, pain management claims might get denied […]

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Wisely Choose Your Orthopedic Billing Partner

Outsourcing is Need of the Hour Nowadays, most of the practices feel comfortable passing the burden of billing and coding onto medical billing partners. Billing companies have medical specialty-wise billing and coding experts who streamline the revenue cycle process for healthcare practice. But not all medical billing companies are the same, some of them may […]

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Reduce Cardiology Denials with Proper Documentation

Importance of Proper Documentation in Cardiology Billing A lot of cardiology claims got denied due to improper and incomplete documentation. It’s really frustrating not to receive insurance reimbursement for the delivered services, though you completed all steps in cardiology medical billing. While focussing on billing and coding guidelines, sometimes cardiologists might not maintain proper documentation. […]

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