New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
The Centers for Medicare and Medicaid Services has taken steps to overhaul codes used for Evaluation and Management (EM) office visit codes. The initiative aims to reduce documentation burdens that interfere with patient care, the American Medical Association says. The professional organization for the nation’s physicians is providing a series of educational materials to support […]
Several CMS-designated permanent and product-specific J-codes recently went into effect, allowing three ophthalmology-minded pharmaceutical companies to expand reimbursement through commercial and Medicare insurance plans. J-codes were activated Oct. 1 for FDA-approved products manufactured by EyePoint Pharmaceuticals, Ocular Therapeutix and Omeros. In the past, J-codes were announced once a year; now, CMS is issuing certain J-codes […]
The right revenue cycle management technology can create a transparent, seamless patient experience, which benefits the bottom line. For the longest time, revenue cycle management has been the man behind the curtain. Healthcare organizations have focused on improving the clinical experience using technology and provider education while telling patients and providers to pay no attention […]
Tips for improving outpatient billing, coding and CDI. In moving from inpatient clinical documentation improvement (CDI) to outpatient CDI, I have been discovering some unique educational pointers. I know we are all very busy, so let’s just dive right into it. Doctors and coders, you should not have diagnoses that are mutually exclusive to one […]
How many times has a provider asked you, “What do I need to document to get a 99215?” All too often, medical coders feel they should help their providers understand what elements of documentation are needed to warrant the higher level evaluation and management (E/M) service. Do not do it! If It Isn’t Documented, It […]
A comprehensive hospital claim validation strategy that prevents denials and improves efficiencies hinges on the right blend of retrospective and pre-bill reviews. The time to strengthen hospital compliance programs through claim validation is now. According to healthcare finance and information management leaders surveyed by HIMSS Media, clinical documentation and coding were the revenue cycle processes most vulnerable […]
A 2016 study in the Annals of Internal Medicine found that for every hour physicians spend in direct face-to-face clinical time with patients, they spend nearly two additional hours on desk work. According to the American Academy of Family Physicians (AAFP), this administrative burden is one of the primary complaints of its members, and prior authorizations top the list of […]
Allzone Management Services, a leading provider of healthcare management services, announced its participation in the Raintree Systems User Conference 2019, an entire conference is centered around deep and meaningful ENGAGEment with users through highly focused workshops, feedback sessions, and industry speakers. The Conference takes place this October 08-12, 2019 at Boston Park Plaza, Boston, Massachusetts. […]
In the crowded healthcare market, smart healthcare leaders must find patient satisfaction advantages everywhere they can. When it comes to patient satisfaction, providing excellent clinical care is a no-brainer. But in a crowded and competitive healthcare market, smart healthcare leaders know that they need an edge everywhere, including an efficient revenue cycle. That’s the case […]