Medical Billing Blog: Section - Claims

Archive of all Articles in the Claims Section

This is the archive containing links to all articles written in the Claims section of our blog.

Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.

6 Tips to Keep Your Finances Afloat During the COVID-19 Pandemic

Medscape offers 6 Tips to Keep Your Finances Afloat During the COVID-19 Pandemic…   1. Cut back on expenses Some household spending has naturally tapered off for many families, as social distancing restrictions reduce spending on eating out, travel, and other leisure activities. But this is also an opportunity to look for other ways to reduce spending. Look through your credit card bills to see whether there are recurring payments you can cut, such as a payment to a gym that’s temporarily closed or a monthly subscription box that you don’t need… 2. Take advantage of regulatory changes Although many physicians won’t qualify for direct payments via the Coronavirus Aid

By: Melissa Clark, CCS-P, RT - CEO
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Better Data Collection is Key to Addressing EHR and Claims Data Discordance

“There is a moderate agreement between EHR data and Medicare Part D (MPD) claims data for the receipt of oral anticancer agents, which are a popular treatment option for cancer patients, according to a study published in JAMA Network Open. The study, conducted by the Texas Cancer Registry and The University of Texas MD Anderson Cancer Center (MDACC), found that 73.8 percent of the EHR data and MPD claims data overlapped, with 176 data sets shown in both and 123 sets not shown for either. Oral anticancer agents are becoming more popular and equally as expensive, leaving policymakers to uncover data about how patients use them, which then allows for

By: Melissa Clark, CCS-P, RT - CEO
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CMS adds 85 more Medicare telehealth services and codes

Becker’s Hospital Review posted that CMS issued various regulatory changes on March 30 to further support hospitals’, physicians’ and other healthcare organizations’ capabilities during the COVID-19 pandemic, including expanding Medicare coverage of telehealth visits.  On March 17, the Trump administration announced CMS will temporarily pay clinicians to provide telehealth services for beneficiaries during the pandemic. CMS is now expanding Medicare coverage of 85 additional services provided via telehealth, including emergency department visits and initial nursing facility and discharge visits.  Here are the 85 additional services, and their respective codes, that CMS will cover when provided via telehealth through the duration of the pandemic:  1. 77427: radiation management 2. 90853: group

By: Melissa Clark, CCS-P, RT - CEO
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7 things to consider when billing and coding for Coronavirus

Becker’s Hospital Review shows us 7 things to consider when billing and coding for Coronavirus…   1. CMS developed Healthcare Common Procedure Coding System code U0001 to allow laboratories and healthcare providers to bill for using the CDC’s RT-PCR Diagnostic Test Panel. Healthcare organizations should use HCPCS code U0002 to bill for validated, in-house developed COVID-19 diagnostic tests, according to CMS. 2. Beginning April 1, laboratories and healthcare providers can bill Medicare and other health insurers using codes U0001 and U0002 for services provided on or after Feb. 4. 3. Local Medicare Administrative Contractors will develop the payment amount for claims received for codes U0001 and U0002 in their respective

By: Melissa Clark, CCS-P, RT - CEO
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5 Common Reasons for Medical Claim Denials

“When a patient’s insurance claim is denied, not only can your cash flow be affected, the relationship with your patient can be damaged as well. Some claim denials can be successfully appealed, but even when appeals succeed, they can temporarily leave claim status up in the air – something both your practice and your patient would like to avoid. Understanding common reasons for claim denials is key to preventing them. The insurers your practice works with may offer software tools to help you prevent claim rejections (which are claims that aren’t processed due to clerical errors) and claim denials (where claims are considered, but payment is denied) so it’s important

By: Melissa Clark, CCS-P, RT - CEO
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One Approach to Achieving EHR Interoperability

While many healthcare stakeholders are dissatisfied with the current state of EHR interoperability and health data exchange, a number of health systems are leveraging existing technology to support care coordination and patient data access. The College of Healthcare Information Management Executives (CHIME) recently recognized a select group of health systems in its 2018 Most Wired list as exemplary organizations embracing new healthcare IT to deliver superior care. Pennsylvania-based Lehigh Valley Health Network (LVHN) ranked third in the nation for its advanced use of health IT. The health system consistently updates its health IT infrastructure and integrates new technologies and data sources into its health IT ecosystem. These ongoing changes support

By: Melissa Clark, CCS-P, RT - CEO
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61% of Physicians Say EHR Systems Reduce Clinical Efficiency

“EHR systems continue to fall short of provider expectations and detract from the joys of practicing medicine, according to a recent national survey by The Doctors Company. More than 3,400 physicians from 49 states and the District of Columbia offered their perspective on EHR technology, federal regulations, value-based care, patient-centered medical homes (PCMHs), and other aspects of the healthcare system. Survey respondents included surgical specialists, primary care providers, and nonsurgical specialists. The majority of respondents were 51 and older. Overall, the majority of surveyed physicians reported that EHR systems have had a negative impact on the patient-provider relationship, clinical workflows, and clinical productivity. Fifty-four percent of surveyed physicians stated their

By: Melissa Clark, CCS-P, RT - CEO
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Billing and coding for advanced clinical practitioners

Melissa’s Mention…   “A 67-year-old patient with diabetes shows up for her appointment. Her A1C levels are high. She reveals during the visit with the advanced practice clinician that she’s not taking her medication as prescribed. The patient’s physician is doing rounds at the hospital and is, thus, unavailable to consult with the patient in person.   At this point, the practice needs to answer a couple questions:   Can the nurse practitioner (NP) or physician assistant (PA) bill the visit under his/her own national provider identification (NPI) number? Or, is the visit appropriate for “incident to” billing and, thus, billable under the physician who created the patient’s care plan?

By: Melissa Clark, CCS-P, RT - CEO
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