Do You Know as Much as You Should About the Medicare Fee Schedule?

  Get Ready for the Annual Update by Reviewing Current PFS Highlights It’s not as highly anticipated as the new NFL season kickoff or the return of pumpkin spice, but CMS’ annual revisions to the Medicare Physician Fee Schedule (PFS) are a fixture of the fall season. We never know exactly what the new year’s … Read more

Do You Know These Front-End Fixes for Common Medical Billing Mistakes?

  Use These Practical Strategies for Keeping Claims from Coming Back Unpaid Remember the kids’ song, “The Cat Came Back?” In the song, old Mr. Johnson tried everything to get an unwanted feline out of his home (including, in some decidedly kid-unfriendly versions, tactics that would provoke The Humane Society’s wrath). But, as the refrain … Read more

What Makes Physician Coding Education Key to Practice Profitability?

  Fill This Hole in Med School Curricula to Manage Revenue More Effectively What didn’t your organization’s doctors learn in med school that they wish they had? Physicians know they have knowledge gaps—from data science and information technology skills to being able to talk about nutrition with patients. Medical schools are changing to help students … Read more

Better Physician Coding Helps You Earn Maximum Revenue the Right Way

  There Is a Better Way to Make More Money Than Filing Iffy Top-Dollar Claims It’s probably happened to you more times than you could count. You’re seeing a patient for “routine” reasons, only to discover you’re dealing with quite a complicated case. Have you had enough physician coding training to code visits like those … Read more

Five Key Questions for Tackling Aging Healthcare Accounts Receivable

  Pursue These Strategies for Getting Outstanding Balances Paid Faster Your organization’s practitioners know the challenges of caring for an aging patient population. But as a billing administrator, you may feel challenged by another aging population—the outstanding balances piling up in accounts receivable (A/R). When insurance claims and patient bills go unpaid for too long, … Read more

Know Why Those “Absurd” ICD-10 Codes Aren’t So Funny After All?

  “Struck by Duck” Makes a Good Meme, but Specific Coding’s a Serious Thing In October 2015, U.S. healthcare providers started using the ICD-10 coding guidelines. But even before the much-delayed implementation took place and even since, this system of over 69,000 diagnostic codes and nearly 72,000 procedural codes has been giving the internet a … Read more

Costly Mistakes to Avoid When Using CPT® and CMS Modifiers

To Capture More Revenue, Master These Commonly Misused Modifiers Despite the thousands of codes in the CPT® codebook (10,155 of them in 2018), you still won’t find one to fit every possible circumstance. That’s when you need to know how to use CPT® and CMS modifiers to ensure you’re properly reimbursed. What are modifiers? They … Read more

How Can You Tell When You Should Use CPT® Code 99233?

  Find out How to Assign This High-Complexity Code with Confidence U.S. physicians are billing for the services they provide during subsequent hospital care with higher CPT® codes than they used to. That’s the finding the HHS Office of Inspector General (OIG) released in a major 2012 study. What’s driving this trend? Yes, sometimes doctors … Read more

How Will CMS Bundled Payment Programs Shape Your Coding?

Know the Issues BPCI Advanced Raises for How You Claim Reimbursement The way you’re reimbursed for the services you provide is changing. Increasingly, fee-for-service (FFS) models are giving way to bundled payment models. These models reward quality, not quantity, of services. They emphasize value over volume, and encourage providers to coordinate care across specialties and … Read more

How to Prepare for an E/M Coding Guideline Audit Before It Happens

Don’t Wait Until an Audit Notice Arrives. Take These Proactive Steps Today. U.S. healthcare spending continues to rise, and news about Medicare overpayments threatening the program’s integrity continues to grab headlines. In March 2018, for example, the Office of the Inspector General’s (OIG) six-month audit of outpatient physical therapy services claims brought to light an … Read more