Many family doctors give wound care to nursing home patients. Proper coding and billing for such wound care are critical to ensuring adequate payment and avoiding potential claims of fraud or abuse. Determining when to describe chemical cauterization of granulation tissue vs debridement is one of the issues in this area, particularly for Medicare patients. The wound care … [Read more...] about What Do You Need To Know About Wound Care Coding?
Medical Billing Process
What Do You Need To Know About Outpatient Facility Setting?
Medical coding is the basic step in the medical billing process. It entails assigning standardized codes to medical diagnoses and procedures. Knowing the thousands of ICD-10 and CPT codes to notify the correct codes for the services provided is one of the most difficult challenges for healthcare organizations. Coding is used for various purposes, including obtaining and … [Read more...] about What Do You Need To Know About Outpatient Facility Setting?
Guidelines For E&M Codes
Congress developed E/M standards and recommendations in 1995 and amended them in 1997.E&M is the abbreviation of evaluation and management codes. E/M coding is the process of converting physician-patient encounters into five-digit CPT codes to enable billing. This coding scheme involves using CPT codes ranging from 99202 to 99499 to reflect services rendered by a physician … [Read more...] about Guidelines For E&M Codes
What exactly is HCC Coding? Guidelines to Risk Adjustment Model
HCC coding stands for hierarchical condition category coding. The Centers for Medicare and Medicaid Services (CMS) implemented HCC coding in 2004 to help estimate Medicare enrollees' healthcare costs for the coming year. An HCC is a kind of chronic medical condition with similar cost patterns. Individual HCCs include diabetes, chronic obstructive pulmonary disease (COPD), … [Read more...] about What exactly is HCC Coding? Guidelines to Risk Adjustment Model
How To Do Medical Coding Audit?
Medical auditing is a systematic approach to peer assessment of medical treatment that identifies and implements possibilities for improvement. Almost any aspect of healthcare can be audited, although most audits focus on payer payment systems to assess compliance with payer guidelines, federal and state legislation. The medical audit plays an important part in a … [Read more...] about How To Do Medical Coding Audit?
Medical Coding Services and Coding Audit
Accurate and efficient medical coding is essential to the ability of the health care company to achieve its financial and regulatory objectives. Outsourcing your medical coding services allows you to fulfil the financial and compliance objectives of your company. Proper medical coding services ensure that mistakes are minimized, lags are decreased, and revenues are optimized. … [Read more...] about Medical Coding Services and Coding Audit
How To Improve Medical Coding Quality
Medical coding is an important part of the claim cycle and is required for claim reimbursement. Incorrect coding can harm your practice in various ways, including lost revenue, potential overpayments, and assertions of abusing reimbursement guidelines. Medical coding has an important impact on revenue cycle performance, so analyzing your coding department is necessary. It can … [Read more...] about How To Improve Medical Coding Quality
Best Practices for Detecting Claim Errors Prepayment
Prepayment is an accounting phrase for paying off a debt or installment loan before its formal due date. A prepayment can be a bill settlement, an operating cost, or a non-operating expense that closes an account before its due date. An individual, a business, or any other entity may make a prepayment. Healthcare prices continue to rise, and revenues remain stagnant; … [Read more...] about Best Practices for Detecting Claim Errors Prepayment
What Should Customers Understand About Surprise Billing?
An unexpected cost, usually for services acquired from an out-of-network health care physician or facility that you were unaware of until you were invoiced. If your health insurance does not cover the total out-of-network cost, you will be responsible for the difference between the billed cost and the amount paid by your health insurance. That is referred to as "surprise … [Read more...] about What Should Customers Understand About Surprise Billing?
Medicaid Coverage and CPT Codes for Orthodontics
Orthodontics is a subspecialty of dentistry. The term "orthodontics" is made up of two Greek words: "orthos," which means "straight or correct," and "dontics," which means "teeth." Thus, orthodontics refers to the practice of straightening misaligned teeth or malocclusions. Orthodontists are dentists who specialize in the Treatment of abnormal tooth, jaw, and face … [Read more...] about Medicaid Coverage and CPT Codes for Orthodontics
UHC Guidelines For Emergency Rooms
United Healthcare is the health benefits division of UnitedHealth Group, a health care and well-being organization dedicated to developing a modern, high-performing health system by improving access, affordability, outcomes, and experiences. Optum, a subsidiary of UnitedHealth Group, provides care supported by technology and data, empowering consumers, partners, and providers … [Read more...] about UHC Guidelines For Emergency Rooms
Blue Cross Blue Shield Texas Guidelines For Emergency Room
Blue Cross Blue Shield of Texas (BCBSTX) provides health care benefits and access to services to assist you in staying healthy. BCBSTX covers all medically essential treatments that Medicaid supports. Its offerings include visits to primary care physicians, specialists (with prior approval for out-of-network doctors), or other providers Routine physicals for children aged one … [Read more...] about Blue Cross Blue Shield Texas Guidelines For Emergency Room
Cigna Guidelines For Emergency Rooms
Cigna is a global American-managed healthcare and insurance corporation headquartered in Bloomfield, Connecticut. Its insurance companies are essential suppliers of medical, dental, disability, life, and accident insurance and associated goods and services, the bulk of which are available through employers and others. It focuses on enhancing people's health, well-being, and … [Read more...] about Cigna Guidelines For Emergency Rooms
Guidelines To Report Pain Using ICD-10 Codes
Pain is a common symptom that doctors treat in all specialties. Assessing patients is problematic because it relies on self-report initiatives that do not capture the complexities of the pain experience. Correct code assignment on claims is also a challenging issue, as the ICD-10 guidelines on how to disclose different types of pain and the code sequence alignment process are … [Read more...] about Guidelines To Report Pain Using ICD-10 Codes
What Do You Need To Know About Urology Billing Services
Urology billing and coding services include billing and coding for all diagnoses and treatments offered to repair urinary system and male reproductive system dysfunctions. Because of its codes and terminology, billing for urology services might be more complicated than for other specialties. Urology billing and coding need particular experience and understanding, which can … [Read more...] about What Do You Need To Know About Urology Billing Services