It is found that nearly 70% of Independent Physicians specialize in a certain aspect of healthcare and that the specialized nature of their practice within the local healthcare community enables them to remain independent. However, reimbursement of physicians working for a hospital or health system is significantly higher than that paid to independent physicians. According […]
Significant reimbursement gap between independent physician and hospital physician
Read More.. Significant reimbursement gap between independent physician and hospital physician
Billing for Worker’s Compensation
Basics of Worker’s Compensation Worker’s compensation, commonly known as worker’s comp, is a type of insurance that covers the treatment of injuries occurring on the job. Employers typically purchase commercial worker’s comp policies directly, although some states administer these policies. Medical billers must therefore remain aware of the worker’s comp policies for their state, including […]
What is Medicare Sequestration?
Providers seeing a 2 percent payment decrease on their Remittance Advice (RA) is due to a mandatory sequestration payment reduction. Claim adjustment reason code (CARC) 253 is used to report the sequestration reduction. The code will appear as a CO 253 on the RA ‘Sequestration-reduction in federal payment’ as the reason. For the Medicare Fee-for-Service […]
Handling Timely Filing (CO 29) Denials
Insurance will deny the claim with denial code CO 29 – the time limit for filing has expired, whenever the claims submitted after the time frame. The time limit is calculated from the date service provided. Each insurance carrier has its own guidelines for filing claims in a timely fashion. Some are as short as […]
Why CAQH is Required for Provider Credentialing?
Credentialing is a systematic approach to the collection and verification of a health care provider’s professional qualifications. The qualifications that are reviewed and verified include, but are not limited to, relevant training, licensure, certification and/or registration to practice in a health care field, and academic background. Insurance credentialing is the process of becoming affiliated with […]
Handling Denial B9 with Modifiers GV and GW
You might have received a denial with claim adjustment reason code (CARC) CO B9. Possible reasons for this denial message could be: The patient is enrolled in Hospice on the date of service Medicare Part B only pays for physician services not related to Hospice condition and not paid under arrangement with Hospice entity Patient’s […]
Medical Nutrition Therapy (MNT) CPT Codes
Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a ‘nutrition-based treatment provided by a registered dietitian nutritionist.’ It includes ‘a nutrition diagnosis as well as therapeutic and counseling services to help manage diabetes. Studies have documented an association between MNT delivered by a registered dietitian and […]
Basics of Co-Surgeon Billing Guidelines
Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants at the surgery. […]
Importance of Medical Coding Audit
It’s an ideal industry practice that everyone who does medical coding (including physicians who code their own work) should have a periodic audit or ‘peer review’ to assure that their skill levels remain high and accurate. Accurate medical coding has a crucial role in healthcare information management and overall quality of care. Although Medical Billers […]
How to Increase Reimbursement for Telephone Calls?
CMS recently announced that it will provide parity in payment for telephone/audio-only services. Specifically, Medicare payment for the telephone evaluation and management visits would be equivalent to Medicare payment for office/outpatient visits with established patients’ effective March 1, 2020. This means that payment for CPT codes 99441-99443 would increase from a range of about $14-$41 […]