Using Modifier 59 (Distinct Procedural Service) Effectively

A modifier should never be used just to get higher reimbursement or to get paid for a procedure that will otherwise be bundled with another code. Modifier 59 describes a distinct procedural service and is used to identify procedures and services that are not normally reported together. For example, it should be used when coding […]


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Improved Acute Myocardial Infarction (AMI) Guidelines

ICD-10-CM implementation brought several significant changes to the OCG (Official Guidelines for Coding and Reporting) with regard to Chapter 9 (Diseases of the Circulatory System) I.C.9.e Acute myocardial infarction (AMI). Preparing yourself for coding updates based on MI type is not sufficient. You also must learn how to apply these new codes using OGC for […]


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2019 NCCI update impact on medical billing and coding

NCCI – National Correct Coding Initiative promotes the correct coding methodologies. Furthermore, it controls inappropriate coding leading to wrong payments in Part B claims. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services. The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool […]


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How to Avoid Common Medical Billing Compliance Pitfalls?

There are several major issues facing compliance officers today, such as HIPAA, Stark Law, and Anti-kickback Statute issues, as well as many billing compliance issues. Billing issues continue to appear in federal government False Claims Act settlement agreements and government audit reports. Here, we’ll discuss incident-to and shared billing compliance pitfalls and focus on what […]


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Prior Authorization and It’s Impact on Practice Collection

Prior authorization is a check run by some insurance companies or third-party payers before they will agree to cover certain prescribed medications or medical procedures. There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. A failed authorization […]


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Impact of High-Deductible Health Plans (HDHP) on Medical Practices

High-Deductible Health Plans (HDHP) have become increasingly popular since the Medicare Modernization Act of 2003 authorized portable, tax-advantaged health savings accounts (HSAs) designed to be coupled with these plans. Supports of HDHP advocate that, these plans as an effective mechanism for controlling health care costs by creating cost-conscious health care consumers who will look for […]


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How to Manage Incoming Calls at Your Medical Practice?

Medical Practice complains about the volume of incoming telephone calls and how much time their employees spend handling them. Why is your Medical Practice getting so many calls? It is the only way patients can make or change appointments. Patients call the office for refill authorization. Patients were distracted during their visits and are calling […]


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What Are The Differences – an Interventional Cardiologist and Invasive, Non-Interventional Cardiologists?

A healthy heart is essential to lead a healthy and happy lifestyle. There are a lot of things that can go wrong with your heart, and sometimes the symptoms that something is wrong are not always obvious. A cardiologist is a health practitioner who specializes in diagnosing problems with the heart and surrounding arteries. What […]


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Outsource Dermatology Medical Billing – Increase Collection by 20%

Dermatology revenue cycle management is more than just dermatology medical billing. It is a service that manages the processes that impact your bottom line from first patient contact to paid account balances and everything in between. The procedure to manage your dermatology treatment center’s revenue cycle management begins before your patient visit and ends when […]


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Reimbursement Methods: Fee-For-Service vs Capitation

As the present USA healthcare trends focusing more on Reimbursement Methods like value-based care, the fee-for-service is under intense scrutiny. Often labeled as an antiquated payment model, it promoted over-utilization by physicians and patients, while creating fragmentation among healthcare service providers. The Affordable Care Act of 2010, along with MACRA legislation in the year 2015, […]


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