The CPT® codes that are considered a laboratory test under the Clinical Laboratory Improvement Amendments (CLIA) change each year, as well as throughout the year, making it difficult for healthcare providers and laboratories to keep up. Here are the CPT codes for 2019 that are subject to or excluded from CLIA edits in easy-to-look up […]
The importance of Artificial Intelligence (AI) in Medical Coding is often understated and also overstating the same is quite difficult.. to get in-depth with how AI is actually bringing changes in MCA, we must get to the basics of what Medical Billing and Coding really are. Medical Coding Medical coding, if we talk about it […]
Every business not only wants to attract new customers but to keep its existing ones, and hospitals and health systems are no different. Unfortunately, surprise medical bills can be the element that drives patients away from one hospital and into the waiting arms of the competition. New research published this month in Health Affairs provides hospitals with […]
President Trump’s fiscal year (FY) 2020 budget allows for $87.1 billion in discretionary budget authority and $1.2 trillion in mandatory funding for the U.S. Department of Health and Human Services (HHS). Although the Centers for Medicare & Medicaid Services (CMS) commands the lion’s share of HHS’s budget, the Trump administration has found ways to cut $395 million […]
The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
A frequent knock on electronic health records has been that they’re just glorified billing systems that fail to provide enough clinical functionality to make a significant difference in quality of care. So it’s somewhat incongruous that a recent Black Book report on revenue cycle management (RCM) system adoption would say that 26 percent of hospitals […]
Cryptocurrency benefits medical billing services, and in turn healthcare staff and patients, in so many ways. Here’s what to know A cryptocurrency is a decentralized virtual or digital currency that’s used as a medium of exchange for using particular products/services. It is like normal currencies but it also facilitates the exchange of digital information. Counterfeiting cryptocurrency is difficult […]
Controversy continues to swirl around this subject. A recent article of mine focused on the argument that Medicare Advantage (MA) plans have to follow the two-midnight rule. It certainly generated buzz; I received a number of emails with comments and questions. First, I want to note that I love getting comments and questions. I can’t […]
Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example: Undercoding Leaves Money On The Table, Driving Down Provider […]
As providers engage in complex payment models and collect more from patients, they must learn to automate key functions to improve healthcare revenue efficiency. The healthcare revenue cycle has many moving parts. From patient access and registration to medical billing and coding, provider organizations of all sizes must achieve revenue cycle efficiency to ensure […]