Tag: Healthcare billing

Seasonal medical coding challenges

Seasonal Coding Challenges: Managing High-Volume Claims

Healthcare providers and their revenue cycle management (RCM) teams face unique seasonal medical coding challenges during seasonal surges in patient care. These seasonal patterns can generate large volumes of claims that require accurate and efficient medical coding, whether they are caused by flu outbreaks, allergies, or elective procedures scheduled before insurance deductibles reset. Table of […]
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2025 CPT Code Updates

2025 CPT Code Updates: Key Changes in Billing and Coding Practices

Each year, updates to CPT® codes are introduced to reflect advancements in medical procedures and technologies, impacting billing and coding across multiple specialties. Effective January 1, these annual updates encompass new, revised, and deleted codes, along with updated coding guidelines. For 2025 CPT Code Updates, there are 270 new codes, 112 revised codes, and 49 […]
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healthcare billing

How AI Revolutionizes Healthcare Billing: Tackling Payment Delays and Denials

During pediatric cardiology internship, witnessed this firsthand. A claim filed nearly a year earlier remained unpaid. The initial denial was due to a missing prior authorization number, a detail buried within the EMR. Unfortunately, the outsourced healthcare billing team took months to decipher this information, causing significant delays in reimbursement. This year-long ordeal highlights the […]
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Modifiers 26 and Modifier TC

Modifier 26 and Modifier TC for Accurate Healthcare Billing

In the realm of healthcare billing and coding, modifiers are crucial tools used to provide additional context and specificity to procedure and diagnosis codes. These modifiers help healthcare providers accurately communicate the nature of services rendered to payers. Two commonly used modifiers, Modifiers 26 and Modifier TC, play significant roles in clarifying billing practices and […]
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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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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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Inaccurate Medical Bills

How to Avoid and Correct Inaccurate Medical Bills

Inaccurate medical bills can be a frustrating and costly experience for patients. From coding errors to duplicate charges, these mistakes can lead to financial strain and unnecessary stress. Understanding the common causes of Medical billing errors and taking proactive steps can help you avoid these issues. Common Causes of Inaccurate Medical Bills 1. Medical Coding […]
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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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Optimize Revenue Cycle Management

Improving Revenue Cycle Management: Insights from Medical Billing Experts

The revenue cycle management process (RCM) must be optimized for financial stability and growth in today’s competitive healthcare landscape. As a result of a smooth RCM process, revenue leakage is minimized and profitability is maximized. With this newsletter, leading medical billing experts share their insights on how to streamline and optimize Revenue Cycle Management. The […]
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