Failure to obtain proper prior authorization is one of the key reasons for claim denials in many medical specialties, and radiology is no exception. Radiology prior authorization is meant to ensure that physicians follow proven guidelines when ordering imaging tests....
The Affordable Care Act (ACA) encourages patients to be much more active participants in their own healthcare and learn about their covered medical services. Medicare beneficiaries now get coverage...
The American Dental Association (ADA) CDT describes Code D4381 - localized delivery of antimicrobial agents (LDAA) via a controlled release vehicle into diseased crevicular tissue, per tooth, as...
Medicare adjusts payments to Medicare Advantage (MA) organizations for cost variations in providing health care to beneficiaries based on various risk factors, including health status. The goal of...
Starting January 1, 2010, Medicare stopped paying CPT procedure codes for consultation services CPT 99241-99245 - office or outpatient consultations and CPT 99251-99255 - inpatient initial...
Insurance verification and authorization is the first and probably most important step in the medical billing process. Patient eligibility verification involves checking out the patient’s coverage...
CMS had granted healthcare providers, hospitals and medical coding companies a one-year grace period for ICD-10-coded medical claims. An ICD-10 coding flexibility policy was implemented last year...
Success in managing the revenue cycle depends on efficient handling of all the processes from patient enrollment and medical eligibility verification to medical coding and billing and payment...
Hypertensive Heart Disease (HHD) refers to damage inflicted on the heart as a result of prolonged high blood pressure (hypertension). It is one of the leading causes of illness and death associated...
Recent changes to both diagnostic and procedure codes as well as variability in requirements across private and public insurers pose many challenges for behavioral health medical billing: ICD-10-CM...
Pulmonary rehabilitation is a multidisciplinary program meant for patients with chronic respiratory conditions, especially for those with chronic obstructive pulmonary disease (COPD). Physicians...
