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.
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 …
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 …
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 …
Study examines mobile technology use in U.S. hospitals
HIMSS Analytics has released its most recent 2017 Essentials Brief: Mobile Study, which provides an overview of the current use of mobile technology – specifically smart phones and tablets – in U.S. hospitals. Essential Briefs are market research studies focused on identifying salient topics in the healthcare IT space that highlight mind share, market share and market opportunity of specific healthcare software technologies. Health IT researchers from HIMSS Analytics examined the strengths and weaknesses of mobile technology use by U.S. healthcare organizations. To uncover areas that have the most promise for the healthcare market, participants were asked to provide thoughts on future needs to ensure further integration of smartphone/tablet mobile …
7 things to know about medical coding and billing specialists
Medical coding and billing specialists are an integral part of hospitals’ and health systems’ efforts to optimize revenue cycle management processes. Here are seven things to know about medical coding and billing specialists. 1. Medical coders are tasked with reviewing clinical documentation and designating standard codes using ICD-10 classifications. Medical billers primarily process and make sure claims are sent to payers for reimbursement of services administered by a provider, the American Academy of Professional Coders states. 2. A hospital or a health system may combine the responsibilities of coding and billing into a single department, or may divide coding and billing operations into two separate branches. AAPC states if the …
