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.

Paper-Based Billing is Ancient History in Healthcare

“Today’s realities are that managing a practice is more complicated than ever…” That’s how an assessment begins on what it takes to successfully run a medical group in 2017 by Triple Tree, a merchant bank focused on healthcare. In a recent report, the bank also looked at the forces driving mergers of specialty groups. Chief among them is the realization by administrators and their physicians that the healthcare business isn’t what they hoped it would be. The mounting pressures are affecting medical groups’ top and bottom lines. The bank’s report suggests that while opting to be part of a larger group might sound attractive to an independent practice, the non-clinical

By: Melissa Clark, CCS-P, RT - CEO
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14 things to know about medical coding

Medical coders play a crucial role in the revenue cycle process, as they help ensure health systems, hospitals and physicians are properly reimbursed for the services they provide. Here are 14 things to know about medical coding. 1. AAPC describes medical coding as “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.” 2. Once medical coding professionals assign a code to a specific healthcare service or procedure, the code is included on an insurance claim, according to AAPC. This code tells the insurer how much it owes for the care and helps determine how much the patient will be billed. 3. Coders use a

By: Melissa Clark, CCS-P, RT - CEO
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Self-service data preparation and analytics

Improving claim collection rates is one way to boost revenue cycle performance, and hospitals can achieve this through various means. Frank Moreno, vice president of product marketing at Datawatch, shared the following tip with Becker’s Hospital Review:”Effective revenue cycle management is only attainable when healthcare organizations have a full view of their patient and operational data. Finance departments cannot wait for IT to provide detailed reports, or spend countless hours manually pulling data from EMRs, 835 and 837 remittance and other files.Yet that’s what is happening at organizations across the country every day. Instead, by using self-service data preparation and analytics solutions, finance teams can easily unlock hidden data to

By: Melissa Clark, CCS-P, RT - CEO
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Making Health IT Safer and Easier to Use

Every day, clinicians work tirelessly to provide the best possible care for their patients. Clinicians and other health care providers like hospitals are increasingly using health information technology (health IT) such as electronic health records (EHRs), and a growing body of evidence shows health IT can help them make care safer. However, new technology can pose challenges and risks. At the Office of the National Coordinator for Health Information Technology (ONC), patient safety is a top priority, and that’s why we maintain the SAFER Guides to help with the implementation decisions clinicians make to reduce EHR associated patient harm. (SAFER is the acronym for Safety Assurance Factors for Electronic Health

By: Melissa Clark, CCS-P, RT - CEO
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Seven Steps to Correctly Code Surgeries

It’s all in how you dissect the operative report. Many coders struggle with coding operative reports because there are so many guidelines and policies that affect code selection. The process is easier when you break it into seven steps: Review the header of the report. Review the CPT® codebook (start in the Index). Review the report/documentation. Make a preliminary code selection. Review the guidelines (for the preliminary codes). Review policies and eliminate the extras. Add any needed modifiers. These seven steps will ensure all the factors that may affect code selection are accounted. Let’s look at an example, and walk through the steps together. Step 1 Review the Header of the

By: Melissa Clark, CCS-P, RT - CEO
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Proper reporting of modifier 99 gets claims paid

Modifier 99 Multiple modifiers doesn’t get a lot of attention — maybe because it’s rarely needed — but knowing when to apply it can make the difference in getting a claim paid. Refer to CPT® Guidance Appendix A — Modifiers tells us: Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. In such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. In practice, call on modifier 99 only if a single line item requires five or more modifiers. The reason is the standard 1500 Health Insurance Claim

By: Melissa Clark, CCS-P, RT - CEO
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Anthem-Cigna deal could improve competition

Three judges heard appellate arguments from Anthem on March 24, as the insurer pled its case against a district court’s ruling blocking its merger with Cigna, Bloomberg BNA reports. Here are four takeaways from the hearing. 1. One judge in the U.S. Court of Appeals for the District of Columbia Circuit said if Indianapolis-based Anthem’s merger with Bloomfield, Conn.-based Cigna led to $2.4 billion in medical cost savings for consumers, as the insurer has argued, it could be beneficial. “That seems like an improvement in competition and consumer welfare,” U.S. Circuit Judge Brett Kavanaugh said, according to the report. Anthem has said a merger with Cigna would allow the resulting

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