Tag: CPT Codes

Reimbursement-methodology

Understanding Medical Codes and Reimbursement Methodologies

The Role of Medical Codes in Reimbursement Methodologies: Medical codes, such as CPT, HCPCS, and ICD-10 (CM and PCS), are essential components of various reimbursement methodologies. The Inpatient Prospective Payment System (IPPS), used by Medicare fee-for-service, categorizes patient stays into Medicare Severity Diagnosis Related Groups (MS-DRGs) based on ICD-10 codes processed through a computerized system. […]
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CPT Codes

The Three Categories of CPT Codes

Table of Contents Category I CPT Codes Category II CPT Codes Category III CPT Codes CPT Code Series and CPT Code List Current procedural terminology meaning: Current Procedural Terminology or CPT codes are developed by the American Medical Association (AMA) to describe a wide range of healthcare services provided by physicians, hospitals, and other healthcare […]
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Telehealth billing guide

Telehealth Billing: What You Need to Know for Success

Telehealth billing, the process of submitting claims for telehealth services, is an essential component of this virtual care model. Efficient and accurate telehealth billing ensures that providers are reimbursed for their services and that patients are not overbilled. The healthcare landscape has undeniably shifted towards a more virtual model. Telehealth, the utilization of telecommunications technology […]
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July 2024 OPPS Update

Comprehensive Overview of CMS July 2024 OPPS Update (CR13632)

The CMS Releases July 2024 OPPS Update (reference: CMS Change Request CR13632, MLN Matters number MM13632). Here’s a summary of key changes: New Coverage for COVID-19 Pre-Exposure Prophylaxis: Drug: PEMGARDA (pemivibart) – Code: Q0224 (Note: This code is not reimbursed under OPPS, but at a “reasonable cost”) Administration: Code: M0224 (Covered: Receives separate payment under […]
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Medical coding Audits

Medical Coding Audits: Trends and Guide for Providers

The landscape of medical coding audits is constantly evolving.  Staying informed about these trends and implementing best practices can significantly reduce stress and ensure a smooth audit experience. The Shifting Landscape of Medical Coding Audits Traditionally, medical coding audits felt like a lottery. Providers faced the uncertainty of random reviews, often scrambling to address issues […]
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Medical coding guide

14 Things To Know About Medical Coding

In this blog, you should know why healthcare providers need to be aware of the medical coding guide. 1. What is Medical Coding? Medical coding is the process of translating medical diagnoses, procedures, and services into universal alphanumeric codes for proper documentation and billing purposes. 2. Importance of Accuracy: Accurate medical coding is crucial for […]
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New Billing Codes-for Prior Authorization Work Proposed by AMA

AMA Aims to Streamline Prior Authorization Billing with New Codes

New billing codes: Medical experts might consider creating new billing codes for the time doctors and their support staff spends working on prior authorizations. The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Board meets May 9-11 in Chicago. On the meeting’s agenda are three potential new CPT codes “for reporting services (physician, QHP, […]
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Preventive-Visits-VS-Office-Visits

Differences: Preventive vs. Office Visits in Medical Coding & Billing

Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is […]
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