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.
How to Collaborate for EHR Usability
The number of health IT developers and products has increased significantly as a result of federal incentives for EHR adoption but correlates with the rise of provider dissatisfaction with the usability of these systems. What providers expect from their EHR systems and what health IT developers deliver have proved not to be one in the same. This disconnect points to the need for the latter to focus on the needs of the former and deliver EHR technology that is user-centered. Therefore, collaboration between health IT developers and clinical end-users is key to ensuring EHR systems are user-friendly in an industry rapidly adopting new technologies year after year to tackle new …
Configuring a chargemaster for medical services
Configuring a chargemaster for medical services is like constructing a building. The more complex the building (or medical services), the more planning, skill, and manpower needed to do the job. The chargemaster of a primary hospital will be different from a tertiary hospital with more acute specialty services. The volume of services rendered gives an estimate of the volume of chargemaster transactions, while the variety and complexity of services rendered gives an idea of the resources needed. Dedicated training, level of expertise, attention to details, and the skill of the chargemaster team determine a successful outcome. The Basics 1. Know your payers and its policies (i.e. what Medicare Jurisdiction the …
Incident-to Coding: Physician vs. Non-physician Provider
Question: Our practice needs to make sure that “incident-to” guidelines are being followed? Part of the Medicare guidelines is that the physician must stay involved in the patient’s care, but they don’t give a specific timeframe. If the patient only sees the non-physician provider (NPP) once or twice a year, and only sees the physician every two to three years, would Medicare consider that as the provider staying involved in the patient’s care? Answer: Once upon a time… Continue reading this article
EHR is Still a Top Buying Priority for Physicians
A recent survey of healthcare executives shows that inpatient and outpatient EHR technology are top of mind for provider buying priorities for health IT purchases, trailing only telemedicine. A third of 248 respondents to a Research Data survey listed telemedicine (33%), inpatient EHR (32%), and outpatient EHR (32%) solutions as their current top health IT buying priorities. The three technologies were well ahead of MACRA implementation and patient engagement, both reported by 20 percent of healthcare executives, as health IT purchasing priorities. The greatest number of respondents — ranging from healthcare CEOs, CIOs, and CFOs to IT, medical, and nursing directors — working in standalone hospitals (47%) and integrated delivery …
Paper-Based Billing is Ancient History in Healthcare
“Today’s realities are that managing a practice is more complicated than ever…” That’s how an assessment begins on what it takes to successfully run a medical group in 2017 by Triple Tree, a merchant bank focused on healthcare. In a recent report, the bank also looked at the forces driving mergers of specialty groups. Chief among them is the realization by administrators and their physicians that the healthcare business isn’t what they hoped it would be. The mounting pressures are affecting medical groups’ top and bottom lines. The bank’s report suggests that while opting to be part of a larger group might sound attractive to an independent practice, the non-clinical …
14 things to know about medical coding
Medical coders play a crucial role in the revenue cycle process, as they help ensure health systems, hospitals and physicians are properly reimbursed for the services they provide. Here are 14 things to know about medical coding. 1. AAPC describes medical coding as “the transformation of healthcare diagnosis, procedures, medical services and equipment into universal medical alphanumeric codes.” 2. Once medical coding professionals assign a code to a specific healthcare service or procedure, the code is included on an insurance claim, according to AAPC. This code tells the insurer how much it owes for the care and helps determine how much the patient will be billed. 3. Coders use a …
Self-service data preparation and analytics
Improving claim collection rates is one way to boost revenue cycle performance, and hospitals can achieve this through various means. Frank Moreno, vice president of product marketing at Datawatch, shared the following tip with Becker’s Hospital Review:”Effective revenue cycle management is only attainable when healthcare organizations have a full view of their patient and operational data. Finance departments cannot wait for IT to provide detailed reports, or spend countless hours manually pulling data from EMRs, 835 and 837 remittance and other files.Yet that’s what is happening at organizations across the country every day. Instead, by using self-service data preparation and analytics solutions, finance teams can easily unlock hidden data to …
Making Health IT Safer and Easier to Use
Every day, clinicians work tirelessly to provide the best possible care for their patients. Clinicians and other health care providers like hospitals are increasingly using health information technology (health IT) such as electronic health records (EHRs), and a growing body of evidence shows health IT can help them make care safer. However, new technology can pose challenges and risks. At the Office of the National Coordinator for Health Information Technology (ONC), patient safety is a top priority, and that’s why we maintain the SAFER Guides to help with the implementation decisions clinicians make to reduce EHR associated patient harm. (SAFER is the acronym for Safety Assurance Factors for Electronic Health …
Seven Steps to Correctly Code Surgeries
It’s all in how you dissect the operative report. Many coders struggle with coding operative reports because there are so many guidelines and policies that affect code selection. The process is easier when you break it into seven steps: Review the header of the report. Review the CPT® codebook (start in the Index). Review the report/documentation. Make a preliminary code selection. Review the guidelines (for the preliminary codes). Review policies and eliminate the extras. Add any needed modifiers. These seven steps will ensure all the factors that may affect code selection are accounted. Let’s look at an example, and walk through the steps together. Step 1 Review the Header of the …
Proper reporting of modifier 99 gets claims paid
Modifier 99 Multiple modifiers doesn’t get a lot of attention — maybe because it’s rarely needed — but knowing when to apply it can make the difference in getting a claim paid. Refer to CPT® Guidance Appendix A — Modifiers tells us: Under certain circumstances 2 or more modifiers may be necessary to completely delineate a service. In such situations modifier 99 should be added to the basic procedure, and other applicable modifiers may be listed as part of the description of the service. In practice, call on modifier 99 only if a single line item requires five or more modifiers. The reason is the standard 1500 Health Insurance Claim …
