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.
Medical Billing vs Medical Coding, What’s the Difference?
Medical coding and medical billing are two of the reimbursement systems within the healthcare organization. The professionals who perform these tasks are known as medical coders and medical billers, respectively. The work of medical coders and medical billers is to analyze medical treatments received by patients while at a healthcare facility to coordinate payments from insurance companies and patients. In this article, we will discuss the difference between medical coding and medical billing. However, it is important to have a brief understanding of what medical coding and medical billing entail. What is Medical Coding? Medical coding is a way of converting healthcare diagnosis, procedures, medical services, and equipment into universal …
Flu Season is Nearly Upon Us… Medical Coding for Influenza Vaccine
Since Flu season is rapidly approaching, we decided to take a look at the medical codes that are utilized for billing of vaccine shots. First of all, what exactly is the Flu? Flu is short for Influenza, which is a contagious respiratory disease caused by the Influenza virus. Influenza virus infects the nose, throat, and in a rare condition the lungs. The symptoms can be mild to severe. The most common influenza symptoms include high fever, sore throat, headache, coughing, runny nose, muscle and joint pain, and fatigue (body weakness). This virus generally occurs during the winter months. Influenza is a serious health condition that can lead to pneumonia. …
Tips for Recouping Lost Revenue From COVID-19 Pandemic
Craig Adkins of AdvancedMD gives HealthIT Answers some tips of how to recoup some of the revenue lost during the pandemic in this article mention. “The past few months of the pandemic have brought many challenges to physician practices, especially small, independent providers operating outside the domains of COVID-19 treatment. While mandatory shutdowns and quarantines have slowed the spread of the virus, the economic impact has been substantial. Fewer outpatient visits—and even fewer procedures—over the past several months have led to serious financial hardship for many providers. Practices that will stay afloat during this challenging time are doing so strategically. In some cases, practices planned for a “rainy day” and …
EHR Training and Experience Lead to Decreased EHR Use by Residents
Are you satisfied with your EHR? Do you spend 40% of your day in your EHR? Research shows that some physicians do.. “Physicians at large community hospitals spend nearly four hours during work hours, or roughly 40 percent of their day, on the EHR, according to a study published in the Public Library of Science (PLOS ONE). Additionally, researchers found a significant decrease in resident EHR use with increased training and experience, although the overall amount of time spent on the EHR remained high. “Studies exploring EHR use emphasized extensive time as one of the significant drawbacks to EHR,” wrote the study authors. “It has been reported that physicians …
6 Tips to Keep Your Finances Afloat During the COVID-19 Pandemic
Medscape offers 6 Tips to Keep Your Finances Afloat During the COVID-19 Pandemic… 1. Cut back on expenses Some household spending has naturally tapered off for many families, as social distancing restrictions reduce spending on eating out, travel, and other leisure activities. But this is also an opportunity to look for other ways to reduce spending. Look through your credit card bills to see whether there are recurring payments you can cut, such as a payment to a gym that’s temporarily closed or a monthly subscription box that you don’t need… 2. Take advantage of regulatory changes Although many physicians won’t qualify for direct payments via the Coronavirus Aid …
Better Data Collection is Key to Addressing EHR and Claims Data Discordance
“There is a moderate agreement between EHR data and Medicare Part D (MPD) claims data for the receipt of oral anticancer agents, which are a popular treatment option for cancer patients, according to a study published in JAMA Network Open. The study, conducted by the Texas Cancer Registry and The University of Texas MD Anderson Cancer Center (MDACC), found that 73.8 percent of the EHR data and MPD claims data overlapped, with 176 data sets shown in both and 123 sets not shown for either. Oral anticancer agents are becoming more popular and equally as expensive, leaving policymakers to uncover data about how patients use them, which then allows for …
CMS adds 85 more Medicare telehealth services and codes
Becker’s Hospital Review posted that CMS issued various regulatory changes on March 30 to further support hospitals’, physicians’ and other healthcare organizations’ capabilities during the COVID-19 pandemic, including expanding Medicare coverage of telehealth visits. On March 17, the Trump administration announced CMS will temporarily pay clinicians to provide telehealth services for beneficiaries during the pandemic. CMS is now expanding Medicare coverage of 85 additional services provided via telehealth, including emergency department visits and initial nursing facility and discharge visits. Here are the 85 additional services, and their respective codes, that CMS will cover when provided via telehealth through the duration of the pandemic: 1. 77427: radiation management 2. 90853: group …
7 things to consider when billing and coding for Coronavirus
Becker’s Hospital Review shows us 7 things to consider when billing and coding for Coronavirus… 1. CMS developed Healthcare Common Procedure Coding System code U0001 to allow laboratories and healthcare providers to bill for using the CDC’s RT-PCR Diagnostic Test Panel. Healthcare organizations should use HCPCS code U0002 to bill for validated, in-house developed COVID-19 diagnostic tests, according to CMS. 2. Beginning April 1, laboratories and healthcare providers can bill Medicare and other health insurers using codes U0001 and U0002 for services provided on or after Feb. 4. 3. Local Medicare Administrative Contractors will develop the payment amount for claims received for codes U0001 and U0002 in their respective …
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 …
