Billing Guidelines for Wound Care in 2022

Basics of Wound Care Active wound care procedures are performed to remove devitalized and/or necrotic tissue to promote healing. Debridement is the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a traumatic or infected wound until surrounding healthy tissue is exposed. These services are billed when an extensive cleaning of […]

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Avoiding Prior Authorization Denials

The burden of Prior Authorization According to a recent survey from the American Medical Association (AMA), prior authorization creates an administrative burden for healthcare practices, negatively impacting providers and delaying patient care. The survey also found that providers complete an average of 41 prior authorizations each week and spend an average of two business days […]

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Reducing E/M Services Claim Denials

E/M Services Denial Reasons As per the Centers for Medicare & Medicaid Services (CMS) data, approximately 15 percent of evaluation and management (E/M) services are improperly paid and accounted for almost 9.3 percent of the overall Medicare fee-for-service improper payment. Some of the common denial reasons are ‘similar services from multiple providers in the same […]

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Guidelines to Avoid External Payer Audit

Understanding External Payer Audits An external payer audit is an examination of a healthcare practice’s finances or processes conducted at the will of payers. These payers are either the government or a commercial insurance company looking to ensure correct payments were provided to the practices for past cases. Government audits can be broken down even […]

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Getting Paid for Telehealth Physical Therapy

Basics of Telehealth Physical Therapy During the COVID-19 pandemic, the federal government has broadened access to telehealth services including physical therapy. With revised billing guidelines, all beneficiaries can now connect with their healthcare providers online, and providers will get the same reimbursement for these services as they would for in-person sessions. Medicare covers three types […]

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Avoiding Improper Medicare Payments for Surgical Dressings

Improper Payment Reasons Durable Medical Equipment (DME) suppliers of surgical dressings and physicians submit claims for surgical dressings and CMS covers it under the surgical dressings benefit i.e., SSA Section 1861[s][5]. CMS recently published Medicare Fee-for-Service (FFS) improper payment rate for surgical dressings for the 2020 reporting period. For this reporting period, the improper payment […]

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Determining Drug Coverage for Original Medicare

Determining Medicare Drug Coverage While billing for Skilled Nursing Facility (SNF) or for hospital billing, billers always make the mistake of considering the wrong Medicare drug coverage. For example, Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are covered under Part D. In this article, we shared […]

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Avoiding Denials of Ambulance Services

Recently CMS published Medicare Fee-for-Service (FFS) improper payment date for ambulance services for the 2020 reporting period. For this reporting period, the improper payment rate for ambulance services was 7.2 percent, with a projected improper payment amount of $349 million. As per the findings, insufficient documentation accounted for 62.5 percent of improper payments for ambulance […]

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Revised Billing Updates for Prior Authorization

Revised Role of Prior Authorization So far insurance carriers have been using prior authorization as a tool to control spending and promote cost-effective care. But in changing billing scenarios role of prior authorizations has changed drastically. There is little information about how often prior authorization is used and for what treatments, how often authorization is […]

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Tackling Ever Increasing Claim Denials

Increasing Claim Denials Recently Kaiser Family Foundation published an analysis on claim denials for various marketplace payers for the year 2020. Under the Affordable Care Act, marketplace payers need to report claims denial data and this analysis used the same data to understand claim denial status. The analysis found that, overall, nearly one out of […]

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