Tag: Medical Billing Services

Surgical Procedure

How to code global surgery modifiers 54, 55, and 56

To understand these modifiers, we first need to review the surgery global period. All medical procedures that include a global period are made up of three parts, explained in more detail later in the article: Pre-operative services Intra-operative services, and Post-operative care. If a physician does not perform all three parts of the service, compliant […]
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The Challenges of Billing Observation Correctly

Observation, outpatient outlier payments, and the Inpatient-only List: Getting it right is not always easy. On this week’s Monitor Mondays we had a robust discussion about Condition Code 44. And on June 9, I will be presenting a webinar on the nebulous concept of “outpatient” service in a bed. Both of these have one thing […]
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How to correctly document and bill for patient e-visits

Q: The providers in our clinic want to start billing e-visits.Can they bill for all the communication between the provider and patient through our online portal? A: As you venture into billing e-visits, on-line visits, digital visits – however you’d like to refer to them – let’s review the required elements for these types of […]
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BMA Supports Bill on Medicare Advantage Prior Authorizations

The bill would aim to standardize processes and require greater oversight on Medicare Advantage plans’ utilization and denial of prior authorizations. Better Medicare Alliance (BMA) has endorsed HR 3173, the Improving Seniors’ Timely Access to Care Act, a law that seeks to reform prior authorization in Medicare Advantage. “When it comes to the use of […]
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mgma requests updates to independent dispute resolution portal | AllZone Management Services Inc.

MGMA Requests Updates to Independent Dispute Resolution Portal

The organization recommended CMS update the independent dispute resolution portal to improve communication between disputing parties and adjust the form field requirements. The Medical Group Management Association (MGMA) has asked CMS to update the federal independent dispute resolution (IDR) portal to streamline the arbitration process for determining an out-of-network payment rate for a surprise medical […]
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HHS requests a hold on its surprise billing appeal

After appealing the courts’ ruling on vacating a piece of arbitration within the No Surprises Act, HHS asks the court for a hold on its plea. HHS recently requested for a hold on its appeal of a Texas federal court ruling vacating parts of the independent dispute resolution (IDR) process in the surprise billing interim […]
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CMS pitches inpatient payment rule for 2023: 10 things to know

CMS released its annual Inpatient Prospective Payment System proposed rule April 18, which proposes a reimbursement boost for acute care hospitals. Here are 10 things to know about the 1,786-page proposed rule: Payment rate update. Under the proposed rule, acute care hospitals that report quality data and are meaningful users of EHRs will see a […]
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How The No Surprises Act Seeks to Change Surprise Billing

The act seeks to reduce surprise billing through independent dispute resolution and incentives for providers to join health plan networks. The No Surprises Act used a couple of methods to reduce surprise billing, though the need for some modifications may remain, according to a resource from AHIP. “The real problem of surprise medical bills tended […]
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new guidelines for billing splitshared visits

Updates Clarify Medicare Split/Shared Billing

Know the facts for ensuring proper payment of these claims in 2022. New policy for split/shared evaluation and management (E/M) visits (including critical care services and prolonged services) was finalized in the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. Knowing the new guidelines for billing split/shared visits performed in the facility […]
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EHR documentation too focused on billing, doctors say

One-third spend at least two hours daily on documentation outside of office American doctors are of two minds when it comes to their EHRs. They are satisfied with the technology overall but resent the amount of documentation time EHRs require for billing purposes. Those are among the results of an analysis of responses to the […]
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