Differentiating Between Medical Necessity and Medical Decision Making

Medical Decision Making specifically refers to the complexity of establishing a diagnosis and/or selecting a management option. Medical necessity refers to the appropriateness of the service provided for a certain condition. Medical necessity determines whether the service will get reimbursed. Problems arise when MDM and medical necessity are used interchangeably, or when practices and payers […]


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ASC Medical Billing: Key Points to Note

ASC stands for Ambulatory Surgery Centers or Outpatient Surgical Center that is a healthcare facility where patients need not be admitted. The patient is simply taken in, treatment is provided and after-care procedures are levied; after which he can leave. ASC is perfect for minor injuries or treatments and is cost-effective, safe, and easy and […]


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7 Questions to Ask Before You Step Towards Outsourcing Your Cardiology Billing

To attain cent percent perfection at cardiology billing is a far-fetched dream for most specialty clinics because of the extensive experience and knowledge it requires. ICD-10 comes with added complexities that raise the stakes for achieving accuracy. Add to its billing code changes and PMP for treatment of certain imaging procedures that often result in […]


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Understanding Medical Coding Modifiers in Orthopedic Specialization

Problems like injuries, congenital deformities or abnormalities, and diseases concerning the musculoskeletal system fall under the purview of orthopedic treatments. Regardless of the nature of orthopedic specialization your clinic excels at successful billing practices demand that your medical billing specialist is well versed in fulfilling the coding demands relative to the specialty field. The correct […]


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Is market for Wound Care service big enough for 2 practices in the same city?

As a practicing for Wound Care service, trends are changing constantly, it is no surprise when I read that the global wound care market is expected to reach USD 20.4 Billion by 2021 from USD 17.0 Billion in 2016, growing at a CAGR of 3.6% from 2016 to 2021. The above figures are based taking into […]


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Steps to Implement a Successful HIPAA Compliance Plan

The HIPAA law to safeguard patient health data is a critical arrangement that is well-known to the people working at the physician’s office. But many still have doubts when implementing a successful HIPAA compliance plan. The healthcare service providers who are not fully informed regarding changes in the law risk potential infringement that couldn’t just […]


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How to Avoid Medicare Audits for ASC Billing Practice?

Be a process owner of a project or CEO of a company, everyone gets sleepless nights with a mere thought of audits. The basic purpose of any audit is to check if everything within the process is maintained properly or not. Ambulatory Surgical Center (ASC) is a healthcare facility that provides medically necessary surgical services […]


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Process of Credentialing for Optometry Practices

Getting credentialed with the right insurance panels is key to growing your practice revenue. However, Credentialing for Optometry Practices can be a daunting task. Are you aware that a Medicare application is a minimum of 30 pages for a solo provider and may surpass 50+ pages if you are a corporation or group practice? Even […]


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