Tag Archives: denial management

What is an ideal denial percentage? Yes, there will always be some denials

The denial rate represents the percentage of claims denied by payers during a given period and quantifies the effectiveness of your revenue cycle management process. A low denial rate indicates a healthy cash flow. A 5% to 10% denial rate … Continue reading

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Top 5 Compliance Issues for Ambulance Biller

Ambulance service billing involves a host of unique compliance challenges. The ambulance industry has seen a significant number of false claim cases, fraud investigations, Medicare audit activity, and other types of billing-related cases. It is imperative that billers fully understand … Continue reading

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Identify Coding Pitfalls to Avoid Common Claim Errors

Coding errors accounted for 8.7 percent of improper payments made by Medicare in 2018, which cost over $2.75 billion. To avoid costly denials and potential payback demands, it’s essential to review code guidelines before submitting your claims. If your practice … Continue reading

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AMA Releases 335 CPT Changes For 2019

The American Medical Association (AMA) announced the release of the 2019 Current Procedural Terminology (CPT) code set on 5th Sept 2018. There are 335 code changes in the new CPT edition reflecting the CPT Editorial Panel and the health care … Continue reading

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Gastroenterology CPT and HCPCS Code Upgrades 2019

On September 5, 2018, the American Medical Association (AMA) released the 2019 CPT Code Set in an official press release. The main theme surrounding new codes, revised codes, and deleted codes is to increase specificity. This is a good time … Continue reading

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New Medicare Enrollment Application (For Physicians and Non-Physician Practitioners)

CMS received approval for a new Medicare Enrollment Application for physicians and non-physician practitioners (CMS-855I dated 12/2018). Many changes are minor; the major ones reduce provider burden: Eliminated reporting for advanced diagnostic imaging, Clinical Laboratory Improvement Amendments number, and the … Continue reading

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Top 7 Challenges with Wound Care Medical Coding

Medical necessity denials traditionally focus on high-dollar MS-DRGs, such as those for hip and knee replacements; other MS-DRGs may also soon become targets. We have identified some of the challenges in Wound Care Medical Coding. Healthcare providers are likely to perform … Continue reading

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