Is Outsourcing Billing, the Right Option for Me?

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 […]


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RCM Strategies to Improve Practice Revenue

Your medical practice revenue is driven, impacted, and influenced by Revenue Cycle Management (RCM) strategies. It includes claims management, patient payments, and your in-house billing workflow. Without implementing these strategies, providers might find it difficult to maintain high levels of clean claims, adjust to an increasing dependence on patient payments, or manage their billing effectively. […]


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Avoiding Coding Audits

Government and private payers conduct audits to find out fraudulent or abusive medical billing practices. As a provider, you deserve to be paid accurately for the medical care you provide. At the same time, it’s essential that you avoid improper billing practices to steer clear of trouble and maintain a flourishing practice. In this article, […]


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Providing Complete Clinical Information to Radiologists

It is not uncommon for radiologists to receive inadequate patient information that potentially compromises their diagnostic decision-making abilities and accuracy. The recent evidence-based study has shown that communication of clinical information to the radiologist, including patient complaints and indications for the imaging request, is required for a quality radiology interpretation process and for making recommendations. […]


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Understanding Medicare Recovery Audit Contractor (RAC) Audit

What is Recovery Audit Contractor (RAC) Audit? As a combined effort to fight fraud, waste, and abuse in the Medicare program, Recovery Audit Contractor (RAC) audit was in place from January 1, 2010. The goal of the recovery audit contractor program is to identify improper payments made on claims for services provided to Medicare beneficiaries. […]


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Understanding PAR and non-PAR Providers with Medicare

PAR and non-PAR Providers with Medicare The Center for Medicare & Medicaid Services (CMS) is a federal agency within the Department of Health and Human Services which manages and oversees the Medicare program for beneficiaries. Physicians are required to comply with numerous laws and regulations related to various aspects of their practice within the Medicare […]


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Documentation for Interventional Radiology

Documentation for Interventional Radiology Many interventional radiologists believe their only audience is the referring physician and fails to remember that there is a larger financial audience which includes medical coders, insurance carriers, auditors, and reviewers to name a few. Even though you know in detail the procedure you performed, unless it is clearly documented using […]


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Appropriate Use of Modifier 25 in Cardiology

Defining Modifier 25 Modifier 25 is defined as a significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. It may be necessary to indicate that on the day a procedure or service identified by a CPT code […]


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CPT Codes for Digital E/M Service

In the 2020 CPT codes set, CMS six released new codes to report online digital evaluation services or e-visits. The codes describe patient-initiated digital communications provided by physicians or other qualified health professionals, codes are 99421, 99422, and 99423. Three others who describe similar interactions when they involve a nonphysician health professional are 98970, 98971, […]


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Basics of Value-Based Care

Basics of Value-Based Care The patient reimbursement model plays a crucial role in patient satisfaction, providers are always trying to improve the patient experience by reducing the cost of service. Most providers use a fee-for-service (FFS) model, which incentivizes physicians based on the number of services provided instead of the quality of care. But value-based […]


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