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.

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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Harnessing Effective EHR Use for Improved Patient Care

Improving EHR use can help reduce physician burnout and strengthen the patient care process. When healthcare providers understand how to best leverage new technologies and are able to adopt and implement an integrated EHR system, both patients and providers will benefit. That has been Kaiser Permanente’s top goal with its EHR safety net programs, looking to reduce errors in the diagnostic process. Kaiser Permanente has developed a total 54 EHR safety net programs, which are collectively called KP SureNet. The programs have helped to close major care gaps over the past few years. Michael Kanter, MD, Medical Director, Quality and Clinical Analysis, Southern California Permanente Medical Group explained to EHRIntelligence.com

By: Melissa Clark, CCS-P, RT - CEO
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CMS Modifies E/M EHR Clinical Documentation Requirements

The American College of Physicians (ACP) recently applauded a CMS decision to change EHR clinical documentation requirements. Teaching physicians can now verify medical student documentation in a patient’s EHR related to evaluation and management (E/M) code services. “Prior to the change, physicians were required to re-document most work performed by medical students — which is often very thorough and based on careful and supervised evaluation — rather than review, refer to, amend, or correct the student note,” clarified ACP President Jack Ende, MD in a public statement. Changing the EHR clinical documentation requirement allows teaching physicians to educate medical students about EHR use within a more streamlined workflow and reduces

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