Category: Blog

CPTModifiers 52 and 53 vs. 73 and 74

Modifier 74 description: Modifier 74 is used in the medical billing and coding field to indicate that a surgical procedure performed in an outpatient setting was terminated due to extenuating circumstances. When this modifier is applied to a billing code, it signifies that the procedure was initiated but discontinued before completion due to reasons beyond […]
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Fight Back Against Denied Insurance Claims: 5 Steps

Appealing a denied insurance claim can be frustrating, but don’t give up! By following these steps and understanding the process, you can increase your chances of getting the coverage you deserve. Here’s a detailed guide: 1. Understand Why Your Claim Was Denied (and Know Your Rights) Review the Denial Letter Carefully: This document should clearly […]
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For First Time, AI Beats Experienced Dermatologists In Detecting Skin Cancer

An international team of researchers say they have developed an artificial intelligence system that diagnoses skin cancer more accurately than trained dermatologists. For the study, a team of researchers from Germany, the U.S. and France trained an AI system to identify skin cancer using 100,000-plus images, including images of malignant melanomas and benign moles. The […]
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July Brings Several Physician Service Code Updates

Here’s a summary of the changes for the July update to the 2018 Medicare Physician Fee Schedule Database (MPFSDB). Changes are effective for dates of service on and after July 1, 2018. Indicator Change for RHC and FQHC Care Management Codes. For the following two HCPCS Level II codes, the PC/TC indicator is changed to […]
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CMS’ Verma Says No To Medicaid Lifetime Limits

Brief:  CMS Administrator Seema Verma on Tuesday said the agency will not approve any state requests to put lifetime coverage limits on Medicaid beneficiaries.  Earlier this month, CMS rejected Kansas’ request to place a three-year lifetime limit on Medicaid benefits. Still, four other states have requested similar Medicaid waivers: Utah, Arizona, Maine and Wisconsin.  Despite […]
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13 New Laboratory Codes – Updates & Changes By CMS

Clinical diagnostic laboratories can look forward to 12 new laboratory codes were effective April 1 and one code effective retroactively January 1. The Centers for Medicare and Medicate Services (CMS) released the changes May 5, 2018. The new codes are contractor priced until addressed at the annual Clinical Laboratory Public Meeting in July. All the […]
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13 New Laboratory Codes

13 New Laboratory Codes – Updates & Changes By CMS

Clinical diagnostic laboratories can look forward to 12 new laboratory codes were effective April 1 and one code effective retroactively January 1. The Centers for Medicare and Medicate Services (CMS) released the changes May 5, 2018. The new codes are contractor priced until addressed at the annual Clinical Laboratory Public Meeting in July. All the […]
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CMS Gives 213 Hospitals Highest Rating For Patient Experience

Brief: CMS’ latest update to its Hospital Compare website gives 213 hospitals top star ratings for patient experience, according to the Advisory Board.  The agency updated the website on April 25, posting new HCAHPS summary star ratings for 3,466 U.S. hospitals. The three-year-old program rates hospitals on 11 publicly reported measures in HCAHPS surveys, which […]
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Adapting Risk Adjustment Coding

Understanding Risk-Adjusted Payment Methodology

The importance of an effective outpatient CDI program cannot be overstated We all know that getting the most accurate and appropriate documentation has always been an issue. Trying to clarify documentation to obtain the most accurate diagnosis coding has expanded to more and more areas, moving from inpatients with DRGs to outpatient with APCs, and […]
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