Common Denials for SNF and How to Avoid Them?

Denial 1: Certification or Recertification Statement (Missing/ Lacked Information) From 2012-2014 the percentage rate of improper payments to SNF almost doubled all stemming from failure to obtain certification or recertification. General Guidelines: The Certification Statement must include that the individual requires skilled nursing (furnished directly by or requiring supervision of skilled nursing personnel) or skilled […]

Top 3 Radiology Claims Denials and How to Avoid Them?

The goal of a well-managed radiology billing operation is to submit claims for services promptly and receive reimbursement as quickly as possible. Timely submission and prompt payment enhance the practice’s cash flow and keep the overall cost of billing at a minimum. All too often, however, payment is delayed because the payer denies the claim […]

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 the nuances of ambulance reimbursement to be able to successfully sidestep these landmines. The following […]

Time-Based Billing for CPT Evaluation and Management

Time-based billing for CPT Evaluation and Management (E/M) services allows providers to select the appropriate level of service based on documented time when counseling and coordination of care are the dominant components of the encounter. Accurate time documentation should clearly state the total time spent, the time devoted to counseling or care coordination, and the […]

Correct Coding for Pre-operative Clearance

Pre-operative evaluation and testing services may not be covered under Medicare. Primary care physicians are often asked to evaluate a patient prior to surgery at the request of the surgeon. Patients at an advanced age and those with significant medical problems face increased risk for surgical morbidity and mortality, and preoperative evaluation will depend on […]

How to use Modifier 25 Accurately for Medicare

Modifier 25 is used when a minor procedure (one with a 0- or 10-day global period) and a significant and separately identifiable evaluation and management (E/M) service are performed during the same session or day. Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the […]

General Surgery Billing Alerts that determine your Revenue Cycle

For a surgeon or medical practitioner, group practice, or clinic, insights into how specialty medical billing works can be a scary task. A billing agent that does not bill the sittings correctly misses deadlines, or does inadequate follow-up can have an abysmal effect on your facilities’ bottom line. However, a well-organized billing service cannot only […]

Avoid the Top 10 Modifier Mistakes – Modifier 58

Matching CPT code with an ICD 10 code, this would seem to be a very straightforward process but there are always variations/exceptions to everything. Sometimes, there are related services that the physician is performing, global periods to contend with, etc. Modifiers will clarify extenuating circumstances, which should allow for payment when they otherwise may not. […]

General Coding Guidelines for Osteoporosis

Osteoporosis is a bone disease that involves abnormal loss of bony tissue resulting in fragile or porous bones. Without appropriate treatment, osteoporosis can worsen. As bones get weaker and thinner, the potential risk for fractures increases. Documentation is very important and physicians must ensure timely medical documentation to ensure appropriate treatment for these patients. Medical […]

How accurate you can use Modifier 58 in Medical Billing?

The modifier 58 is defined by CPT as “staged or related procedure or service by the same physician during the post-operative period.” It may be necessary to indicate that the performance of a procedure or service during the postoperative period was a) planned or anticipated (staged); b) more extensive than the original procedure, or c) […]

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