Billing for Surgical Assistants: What you should know?

Surgical Assistants Practices lose insurance reimbursement by incorrectly billing surgical assistants. In such cases, the major reason for claim denials is to use the wrong modifier/ not use the modifier. In this blog, we tried to cover every aspect of billing for surgical assistants including defining surgical assistants, billing guidelines, reimbursement policies, and accurate use […]

Medicare SNF Billing Coverage 2022

Medicare Part A covers skilled nursing and rehabilitation care in a Skilled Nursing Facility (SNF) under certain conditions for a limited time. Coverage for care in SNFs is measured in ‘benefit periods’ or sometimes ‘spell of illness. In each benefit period, Medicare Part A covers up to 20 days in full. After that, Medicare Part […]

Telemedicine Coverage and Reimbursement in 2022

Increased Scope of Telemedicine Telemedicine and telehealth describe the use of telecommunication tools including the Internet, video, and email to exchange information in the context of health care between patients, providers, consultants, and content for the purpose of education, evaluation, decision-making, and treatment. Prior to the COVID-19 pandemic, telemedicine applications had evolved to broadly cover […]

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 a […]

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 […]

Reducing E/M Services Claim Denials

E/M Services Claim 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 claim denial reasons are ‘similar services from multiple providers in […]

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 […]

Getting Paid for Telehealth Physical Therapy

Basics of Telehealth Physical Therapy Medicare covers three types of telehealth physical therapy services i.e., telehealth services, e-visits, and virtual check-ins. But physical therapist still needs to follow a few basic practices for getting paid for telehealth physical therapy, let’s discuss them. During the c, the federal government has broadened access to telehealth services including […]

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 the Medicare Fee-for-Service (FFS) improper Medicare payment rate for surgical dressings for the 2020 reporting period. For this reporting period, the […]

Determining Drug Coverage for Original Medicare

Determining Medicare Drug Coverage While billing for Skilled Nursing Facilities (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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