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 […]

Time-Based Billing for CPT Evaluation and Management

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 […]

Prominent Ambulatory Surgery Center Medical Billing Functions are Affecting Your Practice Revenue

Compliance guidelines that govern the Ambulatory Surgery Center’s reimbursement are wide-ranging, complex, and ever-changing. Hence, it’s important for ASCs to hire or partner with Ambulatory Surgery Center medical billing and coding management consultants who understand the legal rules placed on ASCs, including specialized coding, accreditation, documentation, and reimbursement care contracts. Here are Prominent Ambulatory Surgery […]

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. […]

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. MBC helps many practices to pinpoint the coding issues so that there will be no Common Claim Errors. […]

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 community’s combined annual effort to capture and describe the latest scientific and technological advances in […]

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 […]

Appropriate Use of Modifiers XE, XP, XS, XU, or 59

Modifier 59 is the most widely used HCPCS modifier. This modifier is associated with considerable misuse and high levels of manual audit activity, leading to reviews, appeals, and even civil fraud and abuse cases. The introduction of four ‘X’ subset modifiers is designed to reduce the improper use of modifier 59 and help to improve […]

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