Tag: Healthcare Reimbursement

Medicare Advantage contract

Avoiding Medicare Advantage Contract Pitfalls: A Guide for Physician Practices

It’s a story many physician practice owners know all too well. A hardworking doctor secures a promising Medicare Advantage contracts with a major payer, expecting substantial revenue—100% of Medicare fee-for-service rates. The new contract seems like a win: more resources for staff, improved facilities, and better patient care. Table of Contents Common Contractual Pitfalls Best […]
Learn More
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 […]
Learn More
Medical Documentation for Better Reimbursement

5 Key Ways to Improve Medical Documentation for Better Reimbursement

Providers and coders should work together to maximize reimbursement by ensuring accurate coding, which is validated by thorough medical documentation. By focusing on ways to improve medical documentation for better reimbursement, providers can enhance patient care and ensure accurate reimbursement. Here are five ways to improve documentation, patient care, and reimbursement: 1.  Avoid EHR Shortcuts […]
Learn More
Prevent Coding and Billing Errors

Preventing coding and billing errors can reduce claims denials

Accurate medical coding and billing are essential components of a healthcare practice’s financial health. When codes for procedures and diagnoses are recorded correctly, providers can receive timely reimbursements for the services they deliver. However, Prevent coding and billing errors can lead to claim denials, delays in payments, and increased administrative burden This blog post will […]
Learn More
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 […]
Learn More
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, […]
Learn More
Value-Based Care challenges

Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

RCM and Value-Based Care Challenges and Opportunities: Healthcare is a dynamic field constantly evolving to improve patient and staff experiences. As the industry transforms, it’s crucial to understand both the potential benefits and drawbacks of these changes. One area experiencing significant evolution is Revenue Cycle Management (RCM). The shift towards value-based care models is a […]
Learn More
Prior Authorization Requirements

Physician Discovers Hidden prior authorization Details in CPT Codes

A proposal to track prior authorization using CPT codes was pulled back for revision after a surprising finding. An urologist, advocated for the plan to compensate physicians for time spent on prior authorization requirements. He also hoped it would streamline the process and improve patient care. However, the American Medical Association (AMA) informed urologist that […]
Learn More
ICD-10-CM coding

Top 10 ICD-10-CM Coding Errors

Medical ICD-10-CM coding accuracy is crucial for efficient healthcare reimbursement. Even minor errors can lead to claim denials, delays, and lost revenue. Here are the top 10 medical coding mistakes to avoid: Accuracy is Key: 1. Don’t Skip the Details: ICD-10-CM codes often require specific details in the fourth and fifth digits. Using truncated codes […]
Learn More
reduce accounts receivable

5 Essential Tips to Reduce Accounts Receivable Turnaround Time

 When your medical practice submits a claim to a payer, the countdown begins until you receive the payment. Ensuring timely payment is crucial for your business, as delays can have costly consequences. Ideally, you should aim to clear accounts receivable within 30 days. To effectively reduce accounts receivable, it’s essential to implement efficient billing processes, […]
Learn More
x