Pre-authorization or written approval from the insurance company is required for certain medical procedures (for example, outpatient surgery, MRI, CT or PET scans, chemotherapy or radiotherapy) prior to the point of service. When you obtain insurance authorizations,...
Common Types of Medicare Part B Claim Denials
Medicare Part B covers two types of services - medically necessary services and preventive services. While Part A focuses on emergency services, Part B covers day-to-day medical needs and this is why Part B claims are crucial for healthcare providers. Once you furnish...
ICD-10-CM Medical Coding for Toxic Reactions
The properties of some drugs, medicinal and biological substances or their combinations may cause toxic reactions in patients. The ICD-9-CM coding system has classified these reactions into adverse effects, poisoning and toxic effects to report on medical claims. All...
Behavioral Health in ICD-10-CM – Features and Top Codes
Medical coding for mental and behavioral disorders in ICD-10-CM is different from that of ICD-9. Though some ICD-10 codes mirror ICD-9, there is expanded granularity for certain categories. More specific clinical documentation is required in such cases to choose the...
Coding for ACA Preventive Services to Curb Tobacco Use
According to the Centers for Disease Control and Prevention (CDC), more people in the United States are addicted to nicotine (the drug found in tobacco) than any other drug. Many clinics are providing preventive services to help tobacco addicted people to control...
Medicare Billing for Spine Surgery in ASCs May be Tricky This Year
The Centers for Medicare and Medicaid Services (CMS) added several new codes for spine surgery on the ambulatory surgery centers (ASC) payable list this year. It is important for all Ambulatory surgical center billing companies to be aware of. This is a very crucial...
Healthcare Providers Still Strongly Favor RCM Outsourcing
Early this year, we talked about the Black Book Market Research survey, revealing the sharp rise of revenue cycle management (RCM) outsourcing among healthcare providers. Now, a new Black Book survey reveals that RCM outsourcing is still going strong in the healthcare...
Medical Coding for Treadmill Stress Testing – An Overview
Treadmill stress testing is a diagnostic test that uses treadmill bicycle and helps physicians to check how well their patient’s heart handles the work and whether the blood supply is reduced in the arteries that supply blood to the heart. This cardiovascular exercise...
Cardiology Medical Billing – Prevent Overdiagnosis
For most physicians, arriving at a proper diagnosis is not an easy task as patients’ symptoms and associated disease conditions tend to evolve over time. Physicians are faced with a lot of uncertainty and probabilities on how a medical condition should be pursued so...
CMS Extends 2014 Informal Review Period to November 23, 2015
The Centers for Medicare and Medicaid Services (CMS) recently announced that the 2014 Informal Review period has been extended to November 23, 2015. Individual eligible professionals (EPs), Comprehensive Primary Care (CPC) practice sites, PQRS group practices, and...