Category: Blog

modifier 58 vs modifier 78

Modifier 58 Versus 78 – Which Should You Use?

Modifier 58 vs Modifier 78: Key Takeaway: Modifier 58: Same underlying condition, planned or unplanned additional procedure. Modifier 78: New problem caused by the initial surgery (complication) requiring a return to the OR. Medical Coders often struggle to differentiate between modifier 58 (staged/related procedure) and modifier 78 (unplanned return to OR). Let’s break down the […]
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HCPCS Level II Codes

HCPCS Level II July 2024 code update

The HCPCS Level II quarterly update for July 2024 is now available on the Centers for Medicare & Medicaid Services (CMS) website. The update includes: 134 added codes 9 discontinued codes 32 codes with long description changes 3 codes with payment changes New HCPCS Level II Codes Effective July 1, 2024, there is one new […]
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Improve-RCM

Boost Your Bottom Line: 4 Keys to Healthcare RCM Success

In 2024, factors like declining reimbursement rates, the shift towards value-based care, and ever-changing regulations demand a proactive approach to improve RCM. Here, we explore four key strategies to optimize your healthcare revenue cycle and ensure financial stability in the coming year. 1. Break down Silos: Merging Front-End and Back-End Functions Many healthcare organizations struggle […]
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Benefits of Charge Capture audits

How Charge Capture Audits Boost Your Healthcare Revenue

The healthcare industry holds hidden potential for improved revenue and streamlined operations. Charge capture audits act as your key to unlock these hidden treasures. Similar to explorers seeking buried riches, healthcare organizations can embark on a quest for financial stability through these audits. This guide will explain charge capture audits, help you identify hidden opportunities, […]
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value based care strategies

 7 key strategies for value-based care in Physician Practices

The Centers for Medicare and Medicaid Services have encouraged physician practices to adopt a value-based care payment model since 2010, following the passage of the Affordable Care Act. A number of models have been tested in order to improve patient outcomes and experiences while reducing unnecessary healthcare expenditures by incentivizing clinicians to provide preventive, proactive, […]
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healthcare denied claims impact and appeals

Unlocking the Secrets of Denied Claims: Insights, Solutions, and Strategies

The Prime Minister’s recent voluntary national survey shed light on the Denied claims. The survey, conducted between October and December 2023, found that nearly 15% of all Medicare Advantage, Medicaid, Commercial and Managed Medicaid claims were denied. Between 45% and 60% of rejected cases were overturned, although the expensive appeals process sometimes meant multiple appeals. […]
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independent-medical-practices

Maximizing Medicare Reimbursement: Strategies for Independent Practices

In the wake of the COVID-19 pandemic, independent medical practices face many challenges, from adapting to new healthcare methods to major regulatory changes. The main focus of this study is to increase Medicare spending. With the right strategies, independent medical practices can achieve financial sustainability while continuing to provide quality care to their patients. This […]
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 2025 CMS Proposed Rule

Proposed Rule for inpatient and LTCHs for FY 2025

2025 CMS Proposed Rule: Announcing this week a proposed rule for inpatient and long-term care hospitals (LTCHs) for the fiscal year of 2025 (FY), federal officials cited an increasing focus on social determinants of health (SDoH). The Centers for Medicare & Medicaid Services (CMS) also prioritized improving maternal health and strengthening emergency preparedness, which noted […]
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Prior Authorization Reform: Progress and Positive Steps

Prior Authorization Reform: AMA’s Impact on Doctors, Patients

 Prior Authorization Reform, a lengthy and often frustrating process for payers to control costs, remains a major challenge for doctors. A recent AMA survey of 1,001 physicians found that 89% of physicians believe prior licensure hurts clinical practice. A surprising 33% said the worst things, such as death or hospitalization, were rights-related.  The AMA recognized […]
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2025 CMS Proposed Rules

CMS Updates Hospice, Palliative Care Regulations for 2025

It’s April, and that means it’s time for proposed rules for fiscal year 2025  to emerge. But the Centers for Medicare and Medicaid Services (CMS) prevailed this year, releasing proposed rules for inpatient rehabilitation, psychiatric patients, hospitals, and skilled nursing facilities (SNFs) in late March. I thought a suggestion was worth mentioning. Additional Benefits for […]
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