Tag: Medical Billing Services

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Keep an eye on Ophthalmology Billing

Learn the nuances of billing these ophthalmology services and reduce your compliance risk. When I first started working in ophthalmology, I worried I would become bored: I mean, after all, it’s just two little eyes, right? I quickly learned how complicated ophthalmology can be and that there are many nuances and layers to coding and […]
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Can you bill E/M from the same appointment?

Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment. Motivated by a desire to avoid audits, many physicians tend to undercode for the work they perform. Others, however, are just unaware that the idea that […]
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Updates on End-Stage Renal Disease Prospective Payment copy

Updates on End-Stage Renal Disease Prospective Payment

CMS issued a proposed rule to update payment rates and policies under the End-Stage Renal Disease Prospective Payment System for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2023. Here are four takeaways from the proposed rule: Under the proposed rule, Medicare expects to pay $8.2 billion to approximately 7,800 facilities […]
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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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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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