Tag: Medical Billing

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 […]
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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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Medicare Physician Reimbursement Cuts

Medicare Physician Reimbursement Cuts Threaten Patient Access to Care

With over 67 million Americans—nearly 20% of the population—relying on Medicare, the program plays a crucial role in ensuring access to quality healthcare. Unfortunately, looming Medicare physician reimbursement cuts threaten to undermine this vital service, potentially leading to reduced access to care and compromised patient outcomes Medicare physician reimbursement cuts, such as the proposed 2.8% […]
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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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Benefits of Outsourcing rcm

The benefits of outsourcing RCM functions

Healthcare providers face a daunting task in managing the complexity of revenue cycle management (RCM) in today’s healthcare environment. One of the key benefits of outsourcing RCM is that it can significantly reduce these administrative burdens. The administrative burdens faced by healthcare organizations often rise as regulations, reimbursement models, and patient expectations change. As a […]
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Healthcare fraud in medical coding

Healthcare Fraud in Medical Coding: Upcoding, Unbundling, and Emerging Challenges

Healthcare fraud in medical coding, particularly through practices like upcoding and unbundling, has become a major concern for medical coding and billing professionals. A recent healthcare market research survey found that 90% of respondents view upcoding as a significant ethical challenge Upcoding involves assigning higher-level codes to medical services than are warranted, leading to inflated […]
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Impact of Healthcare Reform on RCM

Healthcare Reform Update: How New Regulations Affect RCM

Health care in the United States is constantly changing, with new regulations and policies being developed to improve patient outcomes, increase access to care, and reduce costs. Impact of Healthcare Reform on RCM, keeping up with these changes is essential for Revenue Cycle Management (RCM) professionals. New regulations can impact everything from billing and coding […]
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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 […]
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Healthcare reform

Healthcare Reform: How It’s Affecting Medical Billing

Medical billing is shaped by healthcare reform, which is one of the most dynamic forces at play. Legislation, regulatory changes, and shifts in healthcare delivery models have led to a significant change in how providers bill. In response to the continued push for value-based care, increased patient responsibility, and technological advancements, medical billing is evolving. […]
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Future of Medicare telehealth

Future of Medicare Telehealth is Bright and Innovative

Medicare, the federal health insurance program for people aged 65 and older, has been at the forefront of healthcare innovation. In recent years, telehealth has emerged as a powerful tool, transforming the way healthcare services are delivered. As technology continues to advance, the future of Medicare telehealth looks increasingly promising. Telehealth: A Brief Overview Telehealth, […]
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