Arthroscopy coding follows one core rule: a surgical arthroscopy includes the diagnostic arthroscopy, so only the surgical code is reported when both happen in the same encounter. Knee and shoulder procedures add their own bundling rules for debridement, loose body removal, and synovectomy under the NCCI policy manual. Basics of Arthroscopy Coding Guidelines To share […]
A physician or supplier often has a lot of doubts when it comes to ambulance transports and ABNs. Most suppliers consider ABNs a way to avoid Medicare’s medical necessity denials. So let’s dive deeper into a detailed understanding of ABNs, and their appropriate use. ABNs are only rarely appropriate for ambulance services. A physician or […]
Medical practices sometimes equate improper payments with medical billing fraud. Improper payments could be unintentional where your received payment even after not meeting program requirements. While medical billing frauds are intentional where practices might through up-coding and unbundling try to receive more insurance reimbursements than allowed. For differentiating between improper payments and medical billing fraud, let’s […]
Strengthening Affordable Care Act (ACA) Recently, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality healthcare options for millions of consumers. This proposed rule would increase […]
Non-physician providers are healthcare professionals who offer medical services and are not doctors. A non-physician provider (NPP) is a healthcare provider who is not a physician but who practices in collaboration with or under the supervision of a physician. NPPs may bill payers directly, rather than billing under a physician, in certain circumstances. Examples of […]
The general coding guidelines for ICD-10-CM come down to two rules: locate the diagnosis in the Alphabetic Index and verify it in the Tabular List, then report the code at the highest number of characters and level of specificity the record supports. The remaining guidelines cover combination codes, sequela, laterality, and when sign, symptom, or […]
Significance of Patient Experience There is no question that patient experience is a huge factor when it comes to the success of your practice. In case of negative patient experience, their word-of-mouth can adversely impact future patients as well as their willingness to pay bills in a timely manner. The patient experience begins as soon […]
Basics of No Surprises Act The No Surprises Act went into effect on January 1, 2022. This Act is aimed at reducing ‘surprise bills’ to patients in the context of services provided at hospitals and ambulatory surgical centers and includes requirements for hospitals and ambulatory surgical centers, as well as physicians providing services at such […]
Billing and coding for cataract co-management can be tricky. It’s important that all parties involved should get accurately reimbursed for their time and expertise. To explain cataract co-management billing, we discussed everything starting from defining co-management; the relationship between involved parties; required forms to be filled; CPT codes and modifiers; and key boxes in the […]
Medicare Coverage for Ambulance Transportation Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($233 in 2022). All ambulance […]
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