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.

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How to Choose Between Modifiers 25 and 57

When reporting an evaluation and management (E&M) service on the same claim with another service or procedure, you must append either modifier 25 “Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service,” or modifier 57, “Decision for surgery” to the E&M service code. Modifier Identifies Separate Nature of E&M Service A minimal patient evaluation is necessary to determine that a prescribed treatment is appropriate to manage the patient’s condition. For example, if a patient presents for a previously scheduled injection, the provider will briefly evaluate the patient to confirm that the injection remains

By: Melissa Clark, CCS-P, RT - CEO
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Indiana Makes Top 5 States for EHR Adoption

A recent report by the Center for Data Innovation ranked each state based on its rate of EHR adoption and provided recommendations on how policymakers can enable more efficient data use. Data innovation—specifically in the healthcare industry—is imperative to fostering improvements across the care continuum. Researchers at the Center for Data Innovation stated data insights using EHR technology for preventive care and better clinical decision making could cut costs across the industry by up to $450 billion. States were evaluated and ranked for their level of EHR adoption and use according to the availability of high value data sets, development of useful technologies, and proliferation of human and business capital

By: Melissa Clark, CCS-P, RT - CEO
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RCM tip: Stop snail mail for electronic billing

Healthcare organizations should offer electronic billing options patients want rather than use snail mail to send paper statements, according to Jim Denny, president and CEO of Duluth, Ga.-based Navicure. He specifically cited a 2017 Patient Payment Check-Up survey that reveals 89 percent of providers still send paper statements through snail mail, although more than 50 percent of patients prefer electronic bills over paper statements. Given this survey, Mr. Denny shared the following tip with Becker’s Hospital Review. “Despite the abundance of technology that is available, many providers are still billing patients via snail mail. Not only does this way of billing cost more (on average paper billing can cost $7

By: Melissa Clark, CCS-P, RT - CEO
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EHR Dissatisfaction is Contributing to Provider Burnout

“I am a daily user of two EHR systems. One is a community hospital based complex EHR, and one is a cloud and iPad based EHR that we use in our private practice. The private practice-based EHR is much more user friendly and adapts well to our practice. I am what you would consider a “power-user” on our community hospital based EHR, and spend a fair amount of time helping other members of the medical staff better understand and use it. The integrated dictation, patient education, auto-population of data, and macros are just a few of the elements of the EHR that make my life easier, and has the potential

By: Melissa Clark, CCS-P, RT - CEO
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EHR Use Negatively Impacts Patient-Provider Relationship

A recent study by Pelland et al. found that while EHR use may reduce medical errors, the technology is also shown to complicate the patient-provider relationship. Researchers at Brown University performed a qualitative analysis of comments submitted to a 2014 Rhode Island Health Information Technology survey to gain insight into physicians’ personal experiences with EHR systems. Both office- and hospital-based physicians in Rhode Island submitted responses describing their perceptions of the impact of EHR technology on patient-physician interactions. Responses from hospital-based physicians were measured against the opinions of office-based physicians for contrast. While both hospital-based physicians and office-based physicians voiced concerns regarding the effect of EHRs on patient-provider interactions, the

By: Melissa Clark, CCS-P, RT - CEO
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How to Collaborate for EHR Usability

The number of health IT developers and products has increased significantly as a result of federal incentives for EHR adoption but correlates with the rise of provider dissatisfaction with the usability of these systems. What providers expect from their EHR systems and what health IT developers deliver have proved not to be one in the same. This disconnect points to the need for the latter to focus on the needs of the former and deliver EHR technology that is user-centered. Therefore, collaboration between health IT developers and clinical end-users is key to ensuring EHR systems are user-friendly in an industry rapidly adopting new technologies year after year to tackle new

By: Melissa Clark, CCS-P, RT - CEO
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Configuring a chargemaster for medical services

Configuring a chargemaster for medical services is like constructing a building. The more complex the building (or medical services), the more planning, skill, and manpower needed to do the job. The chargemaster of a primary hospital will be different from a tertiary hospital with more acute specialty services. The volume of services rendered gives an estimate of the volume of chargemaster transactions, while the variety and complexity of services rendered gives an idea of the resources needed. Dedicated training, level of expertise, attention to details, and the skill of the chargemaster team determine a successful outcome. The Basics 1. Know your payers and its policies (i.e. what Medicare Jurisdiction the

By: Melissa Clark, CCS-P, RT - CEO
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Incident-to Coding: Physician vs. Non-physician Provider

Question: Our practice needs to make sure that “incident-to” guidelines are being followed? Part of the Medicare guidelines is that the physician must stay involved in the patient’s care, but they don’t give a specific timeframe. If the patient only sees the non-physician provider (NPP) once or twice a year, and only sees the physician every two to three years, would Medicare consider that as the provider staying involved in the patient’s care?   Answer: Once upon a time…   Continue reading this article  

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