Tag: HCPCS Codes

Therapy Services Codes

Therapy Services Codes: A Complete Guide to CPT & HCPCS Codes

Therapy services play a vital role in healthcare, helping patients recover from injuries, manage chronic conditions, and improve overall well-being. To ensure accurate billing and reimbursement, healthcare providers must use the correct therapy services codes. These codes, primarily based on the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), help standardize claims […]
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HCPCS codes G9037 and G9038

New MCP Model HCPCS Codes G9037 & G9038

Clinicians participating in the Making Care Primary (MCP) model now have access to two new HCPCS Level II codes, HCPCS Codes G9037 and G9038, introduced in fiscal year (FY) 2024. These codes expand the scope of interprofessional consultation services, allowing primary care providers (PCPs) to bill for time spent collaborating with specialists. The MCP Model: […]
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Ophthalmology Billing

Navigating Ophthalmology Billing: Challenges & Best Practices

Ophthalmology, as a specialized field within healthcare, presents unique challenges when it comes to Ophthalmology Billing. From the intricate nature of eye-related procedures to various coding requirements, Ophthalmology Billing is a nuanced process that requires precision and understanding. Healthcare providers in this specialty must navigate complex coding systems, insurance policies, and regulatory requirements to ensure […]
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Medical coding challenges

2025 Coding Challenges: Strategies for Success

It is predicted that the healthcare industry will continue to evolve rapidly as we enter 2025. Medical coding, one of the cornerstones of healthcare administration, faces unique Coding challenges that require innovative strategies to succeed. For organizations to maintain accuracy, compliance, and efficiency, it is imperative to stay current with the changing regulations, technological advances, […]
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Healthcare Coding updates

2025 CPT, ICD-11, and HCPCS Updates: A Guide for Providers

Healthcare providers need to stay informed about Healthcare Coding Updates to the Current Procedural Terminology (CPT), International Classification of Diseases (ICD-11), and Healthcare Common Procedure Coding System (HCPCS) in the ever-evolving world of medical coding and billing. To ensure accurate coding and maximize revenue cycles, we must understand these Healthcare Coding Updates as we enter […]
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Medical Coding Denials

Top Strategies to Prevent Medical Coding Denials

Medical coding denials are a common challenge for healthcare providers and revenue cycle management (RCM) teams. They can disrupt cash flow, delay reimbursements, and increase administrative workloads. Avoiding these denials requires a proactive approach that addresses their root causes, ensures compliance with regulations, and fosters a culture of continuous improvement. In this blog, we’ll explore […]
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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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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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Challenges in Insurance Reimbursement

Top 4 Challenges in Insurance Reimbursement Faced by Physicians

Access to beneficial healthcare is largely tied to insurance reimbursements for many Americans. Yet, despite their significance, physicians encounter various obstacles in obtaining these payments. Challenges involve inconsistent reimbursement schedules, payment audits, billing errors, unforeseen denials, lengthy appeals, and services falling outside coverage. These issues can hinder timely care, disrupt service continuity, and leave medical […]
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Tips-To-Maximize-Medical-Billing-and-Coding-Efficiency

Tips To Maximize Medical Billing and Coding Efficiency

Ensuring precise claims processing and prompt reimbursements, healthcare practitioners rely heavily on efficient medical billing and coding procedures. The act of streamlining these functions holds the potential to not only heighten overall effectiveness but also to curtail administrative burdens and mitigate the risk of errors. Within this article, we will delve into a selection of […]
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