Category: Blog

Surgery Modifiers

Surgery Modifiers Require Specific Documentation

Using surgery modifiers to accurately represent the role of assistant surgeons has become increasingly important over the past three decades. Initially, a simple mention of the assistant surgeon’s name in the operative note header sufficed. However, as the healthcare landscape evolved, payers began demanding more granular details about the assistant surgeon’s role and contributions to […]
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2025 Medicare payment policies

Proposed Medicare Payment Policies for 2025

The United States Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) have proposed new 2025 Medicare payment policies for hospitals and ambulatory surgical centers (ASCs) that aim to increase access to care and advance health equity. These policies are outlined in the 2025 Hospital Outpatient Prospective Payment System […]
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Modifier 50

Mastering Modifier 50: Ensure Accurate Billing for Bilateral Procedures

Modifier 50 is used to indicate that a procedure or service was performed on both sides of the body during the same operative session. It’s essential to use this modifier correctly to ensure accurate billing and reimbursement. Key points for appropriate use: Bilateral Procedures: The procedure must be performed on identical, opposing structures (e.g., eyes, […]
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Medicare Advantage Market

Medicare Advantage Market Trends: Growth, Challenges, and Opportunities

Medicare Advantage (MA) has become a dominant force in the Medicare landscape, accounting for over 54% of overall Medicare enrollment. This trend is expected to continue, with penetration rates projected to reach 64% by 2033.  However, the future of the Medicare Advantage market is not without its challenges. The Slowdown Begins While MA has experienced […]
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value-based contracts

Reducing Quality Measure Overload in Value-Based Contracts for Primary Care Physicians

With the proliferation of quality measures in value-based contracts, many primary care physicians feel overwhelmed and set up to fail. Research conducted at the healthcare system shows that these clinicians are inundated with an excessive number of quality metrics, often leading to administrative burdens and reduced patient care. One of the primary criticisms of value-based […]
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Q4 HCPCS Level II code

Q4 2024 HCPCS Level II code Update: new Codes, Descriptor Changes, more

The Centers for Medicare & Medicaid Services (CMS) has announced updates to the Q4 HCPCS Level II code, effective October 1, 2024. These changes include: 58 new codes 10 codes with updated descriptions 6 discontinued codes Key Changes: New codes for medical and surgical supplies, outpatient procedures, durable medical equipment, and orthotic procedures. Replacement code […]
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AI in RCM

AI in RCM: Overcoming Challenges and Enhancing Efficiency

In response, many providers are turning to AI in RCM to alleviate these pressures, leveraging automation to streamline claims processing, improve documentation accuracy, and reduce denials.” This integrates the keyword smoothly while keeping the focus on the challenges faced by healthcare providers and how AI in RCM can help address them. Healthcare providers are facing […]
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Denial prevention

Denial Prevention: A Strategic Imperative for Revenue Cycle Management

Denial prevention has become a paramount focus within healthcare revenue cycles, as the financial toll of claim denials continues to rise. The increasing use of artificial intelligence (AI) by payers has further exacerbated this challenge. To mitigate these losses, a strategic shift is necessary, transitioning from a reactive approach of managing denials post-occurrence to a […]
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outsourcing Revenue Cycle Management

Outsourcing Revenue Cycle Management Services: A Solution for Independent Physicians

Independent physicians, while passionate about patient care, often find themselves entangled in the intricate web of financial management. This has become increasingly challenging with the shift towards value-based care and the growing complexity of payer contracts. Outsourcing Revenue cycle management (RCM), the process of managing financial operations from appointment scheduling to claim settlement, has emerged […]
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