Category: Blog

Debridement Coding

Optimizing Debridement Coding: Tips for Accurate Claims and Payments

The growing U.S. wound care market, fueled by an aging population and rising rates of chronic conditions, presents significant opportunities for healthcare providers. Accurate debridement coding is essential to maximize reimbursement and optimize patient care. Pressure injuries alone affect around 2.5 million Americans each year, leading to more than 60,000 deaths and costing between $9.1 […]
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Modifier 59

How to Use Modifiers 59 and X[ESPU] to Maximize Reimbursement

When you bill for distinct, separate procedures, it’s crucial to know which modifiers will ensure full payment for each service. Modifier 59, “Distinct Procedural Service,” acts as a universal tool to unbundle procedures that are typically included in a larger procedure or “bundled” together. This modifier signals to the payer that specific circumstances justify separate […]
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Medicare appeals process

New CMS Rule: Medicare Appeals Process for Reclassified Patients

On October 11th, the Centers for Medicare & Medicaid Services (CMS) issued a final rule establishing a new Medicare appeals process for Medicare beneficiaries who are initially admitted to a hospital as inpatients but later reclassified as outpatients receiving observation services. This rule is a result of the class-action lawsuit that sought to establish appeal […]
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Medicare Physician Reimbursement Cuts

Medicare Physician Reimbursement Cuts Threaten Patient Access to Care

With over 67 million Americans—nearly 20% of the population—relying on Medicare, the program plays a crucial role in ensuring access to quality healthcare. Unfortunately, looming Medicare physician reimbursement cuts threaten to undermine this vital service, potentially leading to reduced access to care and compromised patient outcomes Medicare physician reimbursement cuts, such as the proposed 2.8% […]
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funniest ICD-10 codes for Halloween

The Funniest ICD-10 Codes for Halloween 2024

Halloween is a time for fun, frights, and… the funniest ICD-10 codes for Halloween? Yes, you read that right! The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a complex system used to classify diseases and injuries. While it’s a serious tool for healthcare professionals, some of its codes can be quite amusing, […]
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Medical Billing Industry

Growth in the Medical Billing Industry: Trends and Challenges

The medical billing industry, while complex and often mired in regulatory hurdles, is experiencing a period of growth and transformation. A recent survey conducted by healthcare software company, a digital health operating system company, revealed that 65% of medical billing companies hold a positive outlook on the industry’s future. This optimism is fueled by several […]
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Healthcare fraud in medical coding

Healthcare Fraud in Medical Coding: Upcoding, Unbundling, and Emerging Challenges

Healthcare fraud in medical coding, particularly through practices like upcoding and unbundling, has become a major concern for medical coding and billing professionals. A recent healthcare market research survey found that 90% of respondents view upcoding as a significant ethical challenge Upcoding involves assigning higher-level codes to medical services than are warranted, leading to inflated […]
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ICD-10-CM and PCS code

ICD-10-CM & PCS Code Changes Every Medical Coder Needs to Know

The recent ICD-10-CM and PCS code updates, let’s delve into a mixed bag of relevant topics. One significant change allows us to assign severity levels for certain eating disorder diagnoses. For anorexia nervosa (both restricting and binge eating/purging types), bulimia nervosa, and binge eating disorder, we can now specify the following severity levels: Mild Moderate […]
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99211 cpt code

You need to know about 99211 CPT code: Guide

Navigating the intricate landscape of medical billing and coding demands a firm grasp of Current Procedural Terminology (CPT) codes. One of the most commonly used yet frequently misunderstood codes is CPT 99211. This low-level evaluation and management (E/M) code is employed for services rendered by healthcare providers, typically in outpatient settings. While it might appear […]
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RCM Outsourcing

Healthcare: The Role of RCM Outsourcing and Technology

The U.S. healthcare industry, marked by its global leadership in spending, faces mounting pressures due to evolving care models, supply chain disruptions, regulations, labor shortages, and rising costs. To navigate these challenges, healthcare leaders are prioritizing quality care delivery while also optimizing administrative operations, including revenue cycle management (RCM). Outsourcing RCM has become a key […]
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