Medical Billing Blogs

With more people opting for dry needling therapy, the complexity of the procedure is on the rise. This means the practices that offer dry needling need to understand how the codes and the billing work to ensure they get paid for their services. Till 2020, there was no specific CPT code for dry needling. Thereafter, the therapists started using CPT Code 97140 to get reimbursement for the services offered. Not only this, the dry needling CPT codes have undergone a change due to the changing rules and regulations, and there are specific CPT codes for dry needling billing to be aware of. The core reason would be the rejection or denial of the payments if unlisted CPT codes were used for the services. Let’s have a detailed look at the CPT codes and dry-needling billing: Know about the New Codes for Dry Needling Billing The dry needling procedure is often referred to as Trigger Point Needling.  The American Physical Therapy Association (APTA)  and American Chiropractic Association (...

Only with time can one become successful in optometry coding and billing. The optometry biller needs to know the difference between medical plans and routine check-ups. They must understand what is applicable in co-pays during a patient visit or how the deductibles will affect the fees. A successful optometrist service is only possible when the practice has efficient   optometrist billing and coding services   in place to ensure the revenue cycle management is flawless.   However, with the complex optometry billing and coding system, many practices have started losing money, eventually affecting patient satisfaction. But here is a brief guide on what your practice needs in optometry billing services to warrant uninterrupted revenue flow to improve such services: 1. Efficient Communication  Almost 90 percent of the claims denied in optometry billing can be avoided with a robust billing strategy, preventing common errors and mistakes. The practice needs to have an...

  Did you know? Podiatry billing and coding involve quite a complex process right from the beginning of the appointment. The onus is on the practice to determine whether the patient needs it for medical reasons and prove that podiatry treatment is necessary. Moreover, there are quite a few nuances to podiatry coding, where meticulous attention is required in determining the correct modifiers and coding knowledge for any inclusive services. The lack of knowledge of the correct modifiers means the practice will suffer from revenue leakage, aged accounts, and maybe even write-offs. Both CMS and AMA state that in podiatry billing and coding , modifiers are vital as it helps the insurance company to understand the procedure and service provided and performed. It is just one of the few issues that can arise from incorrect coding and the inappropriate use of modifiers in podiatry billing. But there are ways to maximize the reimbursement in podiatry billing and ensure steady revenue. T...

  Understanding HCC coding has become critical for healthcare organizations to succeed in new payment models as we transition to value-based care. As a reminder, HCC coding enables providers and billing/coding teams to account for future health risks and costs at the patient level. Thereby, HCC accuracy impacts program success, especially for innovative programs such as Primary Care First. If your patients are not correctly coded, your patient panel may be assigned to the incorrect risk group. Inaccurate risk classification has significant financial implications for the potential payments your healthcare organization will receive. Therefore, it is crucial to implement the following strategies to improve the HCC coding performance: ·          Adhere to the M.E.A.T. Criteria The only way to support a diagnosis for a face-to-face visit is via M.E.A.T. Each encounter should be treated as distinct and in accordance with M.E.A.T. criteria wh...

Like many other practices in the medical field, urology practice has a complicated medical billing and coding process. The already complex process became more challenging when the CPT codes were changed, and ICD-10 was implemented. The new rules and regulations now require urology coding to navigate an arduous path to get paid for the services they have provided. In urology, getting payment becomes harder with the complexity in rules. That’s why it is important for every urology practice to ensure accurate and timely urology billing and coding to enhance reimbursement rates. Tips for Effective Coding For Urology Billing As mentioned in the above section, coding is vital in warranting a successful claim in urology billing and coding. The urology coder must follow the correct coding guidelines keeping in mind the new ICD-10 codes. The coder also needs to assign the diagnosis code of the highest specificity level. There are several ways the urology coding department can take care of the c...

  In 2004, the Centres for Medicare and Medicaid Services (CMS) launched the Hierarchical Condition Category (HCC) code set. While approaching its 20th anniversary, HCC coding is becoming more common as healthcare shifts to value-based payment models, a change that has been actively pursued over the last decade. HCC, as it is colloquially known, was created to estimate and possibly predict a patient's healthcare costs over the course of his or her life. It requires a long-term perspective on multiple conditions, factors, and determinants that may affect their individual prognosis over many months or years. HCC codes are directly related to ICD-10 codes - approximately 10,000 ICD-10 diagnosis codes out of 70,000 diagnoses are directly related to at least one of the 86 HCCs. HCC coefficients vary depending on the patient category. The HCC set assigns risk scores to patients based on demographic factors such as age and gender. There are lot more things to know about the HCC Co...

Pathology laboratories are vital in any medical practice as a unique medical field establishment. However, this kind of establishment can vary in iterations and size and, at times, can be part of the hospital. Most laboratories are established near hospitals or medical practice facilities, given the work it does. While hospital labs generate only 3 to 5 percent of hospital revenue, their findings make 70 to 80 percent of a patient’s   electronic health record (EHR).   Furthermore, CDC estimated that almost 70 percent of doctors’ medical decisions are based on lab test results. This means careful attention needs to be given to improving the revenue process of a pathology lab so that it can invest in the latest testing technology, other lab resources, and staffing so the patient outcome is better. But all these steps begin with proper coding for the pathology tests done, correct Pathology lab billing, on-time claim submission, and minimizing the denials so that patient outcome i...