When you submit a claim to any insurance carrier, it will either get paid, fully or partially, or it might get rejected or it might get denied. Most of the time, providers get confused between claim rejection and claim denial. When a claim is rejected, it generally means details mentioned in the claim are either […]
Medical billing which is part of Revenue Cycle Management represents all activities resulting in receiving accurate payment for services rendered to a patient. Medical billing and coding require specialized knowledge and specific skills which can’t be always handled by providers. There are a number of pieces to the puzzle that go from patients visiting your […]
Medical billing and coding translate a patient encounter into the form healthcare facilities use for claims submission and reimbursement. Medical billing and coding are separate processes, but both are necessary for providers to receive reimbursement for healthcare services. Medical billers and coders play a crucial role in revenue cycle management as their work starts from […]
Recoupment and Refund Recoupment is a request for a refund when an insurance company overpays an account. On the other hand, a billing refund is a technical process of returning the excess money in the specified amount that the party, medical provider, patient, or other responsible parties owes according to the recoupment request. Some of […]
In the US, providers are struggling daily basis with healthcare frauds. These frauds generally cost the healthcare industry 3 to 15 percent of the total expenditure in the United States hence healthcare fraud and abuse must be critical. What are healthcare fraud and abuse? Generally, fraud and abuse are referred to describe a range of […]
If a letter were to arrive at your organization in an innocuous-appearing envelope, you may be afraid to open it. It’s unsettling for a payer to request medical records for claims that have already been paid. It is becoming more and more common for providers to receive what appear to be innocuous medical records requests […]
An Ambulatory Surgical Center (ASC) is defined by CMS as a facility with the sole purpose of providing outpatient surgical services to patients. ASC is a facility that, very simply, specializes in outpatient procedures. Procedures done at an ASC are more extensive than those done at the typical provider’s office but are not so involved […]
Typically, eye care practitioners don’t use the E/M codes for what most Optometry service considers a general eye examination. They are more typically used for patient encounters where the patient presents with a medical complaint or a continuation of medical case management (i.e., glaucoma, allergy, dry eye). The five levels of E/M codes are universally […]
Within the guidelines of the CPT code book, CPT has stated; “When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to […]
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. […]