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.
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 …
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 …
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 …
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? …
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 …
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 …
RCM tip: Invest in automated rules engine to improve RCM
Investing in automation tools, such as a rules engine, can help healthcare organizations decrease their administrative workload, according to Andrew Wade, practice administrator at Conway, S.C.-based Coastal Orthopedics. Mr. Wade shared the following tip with Becker’s Hospital Review: “If we want to truly free up providers from administrative burden and empower them to do the work they love to do — spending more time with patients and delivering quality care — organizations need to invest in tools that automate tasks wherever possible. Thanks to our technology’s rules engine, our claims can be automatically verified and some errors automatically resolved based on knowledge gleaned from the network. We are getting cleaner …
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 …
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 …
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 …
