Medical Billing Blogs

  The hierarchical condition categories, commonly known as HCCs, are vital in medical billing and coding. The knowledge of HCCs is a must now for every medical practice, especially in diabetes, as healthcare organizations have to provide value-based patient care. Though HCCs is a concept that has been introduced previously, it was not at the forefront earlier. But with patient-centric care being the norm of the day, the knowledge of HCCs will enable the practices to reduce the risk of not getting paid or facing a prolonged reimbursement process. This article will discuss some of the basic FAQs on diabetic hierarchical condition categories (HCC) coding.  1. What are HCCs In Diabetes? Hierarchical condition categories (HCCs) coding  is a set of codes in the medical practice that also have specific codes for diabetes associated with certain clinical diagnoses. The Centres of Medicare and Medicaid Services (CMS) have been using HCCs since 2004. They have used it to identify i...

Collecting from patients has become a growing challenge for ASCs in recent years. A growth replicated the continued rise in patient financial responsibility, even after insurance. As patients’ financial responsibility for healthcare costs has shifted, ambulatory surgery centres must commit more attention and resources to collect these higher amounts. In fact, they are making every effort to do so while keeping in mind the stress and struggle that some patients face in covering personal expenses. Regardless of the growing challenges that ambulatory surgery centres collections and their patients face, ASCs must make sure that they have practices in place to assist them in collecting what patients owe for their treatment. Let’s have a deep dive into strategies that can be followed to maximize the collections for your Ambulatory Surgery Centres (ASCs): Devise a defined collections policy It’s critical for ambulatory surgery centres to have a clear col...

In cardiology practice, coding and billing require the cardiology biller to understand and work with complex procedure rules and contractual adjustments while keeping up-to-date with the changing codes and billing regulations. Though using CPT codes can be challenging, mainly when modifiers are to be used, it becomes more stressful for the biller when codes are revised, new codes are added, and some are deleted. All this indicates that cardiology billing poses quite a unique set of challenges and opens a path for error. Thereby, the cardiology billing errors would lead to a loss of revenue and negatively impact the practice. But there are several ways to avoid errors in cardiology billing, which will warrant uninterrupted revenue collection while you can better care of the patients. These are as follows: 1. Documentation Undoubtedly, ensuring correct and complete documentation is a must in cardiology billing. But simultaneously, the tricky nature of cardiology documentation can result ...

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...