One of the most frequent errors can result from the submission of invalid modifier combinations. In addition to the accurate coding of treatment, medical claims must be billed in combination with codes for additional services performed in the office, the corresponding modifiers, if necessary, and ICD-10 or diagnosis codes. In this article, we will be […]
Reference (Outside) Laboratory: When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding Modifier 90 to the usual procedure number. For the Medicare program, this modifier is used by independent clinical laboratories when referring tests to a reference laboratory for analysis. Modifier 90 […]
All hospital staff members working in the wound center provide services under the direct supervision of an advanced practitioner (AP) (I.e. physician, podiatrist, or nurse practitioner). The practitioner can be employed by the hospital or in private practice. There have been cases in which providers’ alleged failures to satisfy provider-based criteria have given rise to […]
The Medicare National Correct Coding Initiative (NCCI) includes Procedure-to-Procedure (PTP) edits that define when HCPCS)/ Current Procedural Terminology (CPT) codes should not be reported together either in all situations or in most situations. For PTP edits that have a Correct Coding Modifier Indicator (CCMI) of “0,” the codes should never be reported together by the […]
The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a […]
Claims Denials for OB/GYN are a thorn in the flesh for most medical practices. However, some specialties have an exceptionally high denial rate. Unfortunately, OB/GYN is one of them. Denial rates in this specialty are the highest, at 22.42%. Denials are an everyday occurrence for most OB/GYN centers. OB/GYN billing and coding present unique challenges […]
Healthcare Revenue Cycle Management Healthcare Revenue Cycle Management professionals use information technology to track claims throughout their lifecycle. This is necessary to ensure payments are collected and denied claims are addressed. However, some hospitals struggle to implement information technology and billing infrastructure that successfully manages claims and large outpatient networks. Effective health information technology is […]
The Durable Medical Equipment Medicare Administrative Contractors (DME MAC) are changing the requirement that medical coders to use the RT and LT modifier for certain HCPCS codes, and that the modifiers be used when billing two of the same item or accessory on the same date of service and the items are being used bilaterally. […]
Therapy Practice Accelerator is a proven, empowering system that gives therapists the missing pieces that let you build the full practice you envision. The schedules of physical therapists tend to be extremely busy. With the digital age being in full swing, your attention and focus can be pulled in many different directions affecting overall productivity. […]
If a letter were to arrive at your organization in an innocuous-appearing envelope, you may be afraid to open it. It’s unsettling for a payer to request medical records for claims that have already been paid. It is becoming more and more common for providers to receive what appear to be innocuous medical records requests […]
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