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?
Utilization management is crucial to ensure people have access to the appropriate care in the right place and at the right time. The value-based care strategy includes utilization management (UM) reviews. They want to know if patient care is appropriate, efficient and connected to better patient outcomes. The insurance company's UM processes include prior authorization, … [Read more...] about Difference Between Prior Authorization And Predetermination
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
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
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
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?
Cracked tooth syndrome (CTS) is a condition when a crack occurs in your tooth or you have a fractured tooth. Sometimes the damage is minor and harmless and sometimes it causes your teeth to crack or split. Age, tooth grinding, trauma, and other reasons can lead to a broken or cracked tooth. You may not notice any signs of a cracked tooth. You may also experience discomfort and … [Read more...] about ICD-10 codes for Fractured Tooth
A root canal is a dental operation that involves the removal of the tooth's soft interior to protect your tooth. It is also known as pulp and pulp is composed of nerves, connective tissue, and blood arteries that helps in the tooth's growth. The pulp runs from the tooth's crown to the tip of the roots, where it links to the tissues that surround the root. The pulp is essential … [Read more...] about CDT Codes For Root Canal Procedure
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
Insurance verification and authorization are crucial components in the revenue cycle management or medical billing insurance claims process. RCM is the financial process used by healthcare institutions to track patient care experiences from registration and appointment scheduling until final payment using medical billing software. Insurance verification and prior authorization … [Read more...] about Difference between Insurance Verification and Insurance Authorization
When the patient's condition is such that any other mode of transportation would risk the patient's health, ambulance transportation is a recognized service, e.g. suppose a patient has been in a car accident; the ambulance carries the patient to the hospital, and the patient arrives for treatment. There are CPT codes for ground ambulance services that include both land and … [Read more...] about CPT And HCPCS Codes For Ambulance Services
Dermatology practices face distinct medical billing and coding problems due to their specialty. Because dermatology needs both medical and surgical features, dermatology medical billing can be extensive and necessitates a thorough grasp of dermatological CPT codes, modifier usage, and other considerations. With electronic health records, proper, appropriate coding and … [Read more...] about Medical Coding Guidelines For Dermatology
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 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
Medical coding terminology can be intimidating, but it doesn't have to be. Medical billers and coders must be familiar with medical coding terminology, including names of conditions and illnesses, treatments and medications, and medical code vocabulary. Our team remains updated with changing coding standards as an experienced medical billing and coding company in the … [Read more...] about What Do You Need To Know About Medical Coding Key Terms