Tag: Reimbursement

Mastering Chronic care management codes

Chronic Care Management Codes: A Comprehensive Guide

Chronic Care Management codes are increasingly being adopted by healthcare providers to address care fragmentation for patients with multiple chronic conditions. However, a recent study published in the American Academy of Family Physicians suggests that while CCM is gaining traction, challenges persist in its implementation and reimbursement. A Growing Trend The study, which analyzed Medicare […]
Modifier 25

Understanding Modifier 25: A Comprehensive Guide

Often, a seemingly routine preventive visit or minor surgery can take an unexpected turn when a patient mentions a new concern, such as “Oh, by the way…” If a physician provides additional care beyond the originally scheduled service, you may be able to bill for a separate evaluation and management (E/M) service using modifier 25. […]
Medicare Physician Pay Cuts

CMS Finalizes MPFS with 2.9% Medicare Physician Pay Cuts

The Centers for Medicare & Medicaid Services (CMS) has finalized its 2025 Medicare Physician Fee Schedule, which includes a 2.9% Medicare Physician Pay Cuts to physician payments. This decision, despite opposition from major industry groups, will impact healthcare providers and potentially patient access to care. The rule also includes several positive provisions, such as expanded […]
2024 ICD-10-CM Code

ICD-10-CM Code Changes: What You Need to Know

The healthcare industry is no stranger to constant updates, especially when it comes to coding and billing. As medical knowledge advances, disease trends change, and the healthcare landscape evolves, the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) update the 2024 ICD-10-CM Code set every year Healthcare providers, […]
2024 Medical Coding Updates

2024 Coding Updates: Navigating New CPT, HCPCS, and ICD-11 Changes

In 2024, healthcare providers, medical coders, and revenue cycle management (RCM) professionals need to stay up-to-date on 2024 medical coding updates. Several updates have been made to Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases (ICD-11) by the American Medical Association (AMA), the Centers for Medicare & Medicaid […]
ICD-11 Transition Guide

Navigating the Shift: Preparing for the ICD-11 Transition in 2024

The healthcare industry is on the verge of a significant transformation as we approach 2024: transitioning from ICD-10 to ICD-11. Healthcare providers, payers, and patients alike will all be impacted by this shift, which promises to revolutionize the way medical diagnoses and treatments are documented and reported. Our comprehensive guide explores the intricacies of ICD-11, […]
compliant coding and billing

Compliant Coding and Billing for Physicians: Expert Tips

The article explores common billing mistakes and offers tips for four healthcare services that can cause payment headaches for physicians. 1. Annual Wellness Visits vs. Physicals: Understanding Medicare Requirements Differentiating between Annual Wellness Visits (AWV) and Initial Preventive Physical Exams (IPPE) is crucial for accurate billing. Both are covered by Medicare for preventive care, but […]
CPT Modifier

Six Tips to Getting Paid for CPT Modifiers

In medical coding, CPT modifier are vital for accurate reimbursement of healthcare services. These special codes, attached to primary procedure codes, provide additional details about the complexity or extent of a service. However, using modifiers incorrectly can lead to claim denials and lost revenue. This blog post shares six key tips to help you get […]
modifier 58 vs modifier 78

Modifier 58 Versus 78 – Which Should You Use?

Modifier 58 vs Modifier 78:  Modifier 58: Same underlying condition, planned or unplanned additional procedure. Modifier 78: New problem caused by the initial surgery (complication) requiring a return to the OR. Medical Coders often struggle to differentiate between modifier 58 (staged/related procedure) and modifier 78 (unplanned return to OR). Let’s break down the key differences […]