Medicare 8-minute Rule Billing: Also Known As Direct Time CPT Codes

Posted on November 30th, 2023 / Under Medical Billing / With No Comments

Underbilling is a serious issue in the healthcare industry, and one primary cause is the providers’ lack of knowledge regarding Medicare rules. One commonly understudied Medicare rule is the 8-minute rule.

At first glance, the Medicare 8-minute rule seems fairly straightforward; treatments are billed to Medicare in units, and treatment must last no less than 8 minutes for a unit to be billed to Medicare.

Unfortunately, oversight in this regard could lead to mistakes, resulting in problems like incorrect billing, underpayment, or delayed reimbursement.

As a provider, here is how to avoid mistakes when using the 8-minute rule units to bill Medicare.

Understanding the 8-minute Rule in Billing

As established earlier, to receive payment from Medicare for some CPT codes, a provider should provide direct treatment to a patient for a minimum of 8 minutes. 

Any service, specifically outpatient therapy services like physical or occupational therapy, that lasts less than 8 minutes in duration, cannot be billed to Medicare. This rule also only applies to time-based CPT codes. 

It’s also crucial to understand that only certain services fall under this rule, such as Medicare Part B services. It also applies to payers who follow Medicare billing guidelines; in addition, the 8-minute rule only applies when the service is performed in person.

Services covered by the Medicare 8-minute rule are billed in 15 units. 

For example, if a service lasts anywhere between 8 to 22 minutes, it would be billed in a single unit. But if the service takes more than 22 minutes, such as 37 minutes, Medicare will be billed 2 units for each 15-minute interval and so on. You can review the Medicare 8-minute rule chart for a clear understanding of billable units.

Medicare's 8-Minute Rule Chart

However, any services that last less than 8 minutes may not be separately billable. In case a patient is provided more than one service or procedure in a single minute, Medicare would review the combined minutes of each service. If the combined minutes pass the minimum threshold of 8 minutes, Medicare can be billed separately for each type of service. 

The CMS 8-minute rule applies to outpatient service providers, including hospital outpatient departments, private physical therapy clinics, rehabilitation facilities, occupational therapy clinics, nursing facilities, and speech-language pathology centers. 

Medicare rules, such as the AMA 8-minute rule, do not apply to non-medical insurance unless stated explicitly in their policies. That is because most private insurance companies don’t allow mixed remainders. 

Mixed remainders are referred to as the leftover hours of a multiple-timed service that do not meet the minimum threshold. Mixed remainders from different services can be combined to meet the 8-minute threshold and be billed as units. Moreover, the 8-minute rule also applied to Medicaid services. 

You can also refer to the 8-minute rule cheat sheet to understand the difference between billing for insurances that follow CMS guidelines and those that follow AMA guidelines.

Difference Between Time-Based CPT Codes and Service-Based CPT Codes

Service-based codes are generally untimed and billed as a single unit as they do not depend on the amount of time a service takes. Some common examples of service-based codes are E/M (Evaluation and Management) codes, procedures, and diagnostic tests. Service-based codes are reimbursed depending on the complexity of the service provided.

On the other hand, time-based codes are billed in 115 increments, depending on the amount of time spent on a service. There is also a set of rules that apply to make time-based codes billable. For example, the service provided should have been one-on-one for a time-based code to be reimbursed.

In some cases, time-based units and service-based units can be a part of the same treatment session, but they will still be billed separately.

Calculating Billable Units

Knowing how to calculate medical billing units is essential for claims scrubbing and submission. Here is how you can calculate billable units.

  1. Firstly, calculate the number of minutes spent on a service.
  2. Divide the total number with 15. This would give you the amount of billable units.
  3. Now, identify any leftover minutes. If there are multiple leftover minutes from different services, you will now have what is called a mixed remainder.
  4. If the mixed remainder is equal to or greater than half of the minimum threshold (which in this case would be 4 minutes), it can be rounded up to another billable unit.

Consider this example: if the total number of minutes you spent on a time-based service was 30, you can divide it by 15. This way, you will get two billable units.

Key Differences Between Rule of 8s and 8-minute Rule

Many people confuse the rule of 8s with the Medicare 8-minute rule when, in fact, the rule of 8s is the label used to describe the 8-minute rule in the CPT code manual. Typically, the rule of 8s is applied to non-medical insurance payers for Direct Time CPT Codes.

While the rule of 8s follows the same principles as the 8-minute rule, there is a bit of distinction. For instance, the rule of 8s requires practitioners to provide at least half of the service to bill for one unit.

8-minute Rule Mistakes to Avoid

It can be challenging to properly bill under the Medicare 8-minute rule for physical therapy. 

There are often certain mistakes people make, like presuming they’ll be getting charged extra for services lasting longer than 8 minutes or believing that this rule applies to all types of services provided by their assigned physician. 

Physicians should discuss the 8-minute rule with Medicare beneficiaries to alleviate their concerns and answer relevant queries. 

On the provider end, to avoid any billing mistakes while using the 8-minute rule, you should, 

  1. Accurately document the total time spent performing billable activities. 
  2. Bill in correct increments. For instance, bill for three units if the total time spent on service is 52 minutes. 
  3. Assign correct CPT codes to the services provided. 
  4. Provide clear and concise documentation detailing the services provided to the patient and the patient’s response to the treatment. 
  5. Train your healthcare staff on how to utilize the Medicare 8-minute rule properly. 


How many minutes are in a billing unit?

According to the 8-minute rule by Medicare, a billing unit typically equals 8 minutes of a physician’s time. So, if a physician performs a service that takes around 8 minutes, it will be billed as one unit. 

8-minute rule importance in physical therapy?

The 8-minute rule guides physical therapy specialists on how to properly document their time during a patient encounter and perform accurate billing for reimbursement. Adhering to the 8-minute rule helps physical therapy clinics optimize revenue.


Medical Practice Management Software: Various Uses For Maximizing Healthcare Efficiency Including Billing Tasks

Posted on November 29th, 2023 / Under Medical Billing / With No Comments

People belonging to the healthcare industry, whether therapists, direct care practitioners, specialists, or chiropractors, all know that the realm of medical practice is extremely fast-paced. 

Managing all operations from the front desk to the back office can be considerably challenging for healthcare organizations. But this is where a Medical Practice Management Software, also known as PMS, comes in.

The benefits a PMS brings to the table for a healthcare practice go beyond just organizing patient records, reporting, and appointment scheduling. In fact, it plays a much more pivotal role, streamlining some crucial operations, including billing tasks.

Let’s dive right in and learn the importance of cloud-based medical practice management software, its critical features, and its benefits.

Importance of PMS in Healthcare

Practice management involves both routine operational and financial tasks. Many large hospitals and healthcare organizations have professionals overlooking such tasks, but it’s often challenging for small and medium-sized healthcare practices to do the same.

So, instead of handling the administrative burden of keeping every operation organized on its own, small and medium-sized practices can invest in medical practice management software. 

There are typically four main types of PMS, cloud-based medical practice management software, desktop-based PMS, client-server PMS, and on-premise PMS. To choose the right PMS for your practice, consider checking medical practice management software reviews.

Overall, a PMS can significantly contribute to the efficiency of a practice. Let’s break down the tasks a PMS can streamline for healthcare organizations.  

  1. Keeping sensitive patient information protected against breaches. 
  2. Automating appointment scheduling to reduce wait times. 
  3. Recording and managing patient demographic information. 
  4. Reducing the likelihood of errors in the medical billing process. 
  5. Integration with payers to improve information exchange and streamline claims submission. 
  6. Generating reports to facilitate audits. 

Features of Medical Practice Management Software

Each PMS in the market comes with a distinct set of features, but let’s review some standard medical practice management software features you should look for.

1. Integration With Other Systems:

PMS can seamlessly integrate with other systems like EHR, EMR, and Telehealth functionalities. This type of integration improves the overall quality of patient care. 

For instance, integration with an EHR (Electronic Health Records) system contributes to error reduction and provides easy access to patient information. 

It also minimizes the need for manual data entry, allowing physicians to easily access and update patient information and make informed medical decisions. 

Similarly, integration with Telehealth facilitates the continuum of care, allowing physicians to conduct virtual consultations and share electronic prescriptions with patients. 

2. Streamlining Billing Processes: 

Billing accuracy is fundamental for any medical practice, and it can be achieved with the help of PMS. The billing management feature allows you to make online payments and create and send invoices.

It also helps minimize the need for separate billing software by eliminating coding errors. This improves reimbursement rates and cuts down the administrative burden on the healthcare staff, allowing them to focus more on providing quality patient care.

3. Enhancing Patient Engagement With Patient Portal: 

One practical feature of the medical practice management software is allowing patients to participate virtually in their healthcare journey.

Through patient portals, patients are able to access their test results, access medical records, and schedule appointments with their physicians. This increases patient satisfaction.

4. Resource Management:

The resource management feature allows practices to utilize the PMS to keep track of the inventory. Practices can also create and manage schedules for equipment maintenance and automate the process of reordering medical equipment. 

5. Reporting: 

Practice management tools allow you to generate reports on insurance claims, patient demographics, and much more. These reports allow practices to analyze financial and operational performance and make data-driven decisions.

Essential Benefits of Using PMS

• Reduced Administrative Burden:

With critical tasks like generating invoices, managing appointment schedules, bookkeeping, collecting patient demographics, and more just a single click away, a medical practice management system greatly reduces the administrative burden on the staff of a healthcare practice. This allows the providers and staff to avert their attention to the delivery of high-quality patient care. 

• Minimizing Wait Time and No-Show Rates:

Automating appointment scheduling allows providers to organize the schedule and minimize any delays, reducing wait time during appointments. PMS that contain medical CRM functionalities allows practices to send appointment reminders to patients, minimizing no-show rates due to missed or forgotten appointments. 

• Seamless Billing: 

Medical practice management software eliminates the need for any paperwork for billing. Providers can keep track of all payments and invoices using PMS. This also expedites the claims submission process and reduces claim rejection rates. 

• Data Centralization:

With financial, patient, billing, and insurance information accessible in a single software, billing specialists, healthcare providers, and the administrative staff can collaborate seamlessly. Data centralization ensures the personnel of a medical practice are on the same page. 

• Effective Communication:

Not only does PMS improve communication between physicians and patients but also allows integration with systems present on the payers’ ends, streamlining the exchange of information between billers, coders, and payers. 

• Improved Patient Care: 

Improving patient care is the bottom line for any healthcare practice, and implementing medical practice management software is a gateway to improved patient care and satisfaction. PMS reduces errors in medication and diagnosis, fostering better clinical decisions and improving patient outcomes.

• Transparency

With the accessibility of generating performance reports, practices are able to analyze them and identify areas that require improvement. 


What are the key features of Medical Practice Management Software?

All patient management software in the market are different in some aspects, but some key features of practice management software include billing, scheduling, coverage verification, business intelligence, and patient data management. 

What is the difference between EHR EMR and Practice Management Software? 

EHR and EMR systems are primarily designed to facilitate practices in managing patient health data. However, EHR systems offer a more comprehensive view of such data.

On the other hand, practice management software also streamlines the operational and financial aspects of a practice, focusing on processes including billing and scheduling.


Physician Fee Schedule Policy Changes: Lookup Medicare PFS Proposed Rule

Posted on November 28th, 2023 / Under Medical Billing / With No Comments

The Medicare physician fee schedule dictates how services rendered by healthcare providers are compensated under the Medicare program for their services. 

Centers for Medicare and Medicaid regularly update the physician fee schedule to align with technological changes and concurrent transformations within the healthcare industry. 

Some exciting transformations are awaiting the healthcare landscape in the upcoming year and at the forefront lies the 2024 Medicare physicians fee schedule proposed rule

Similar to the CY 2023 physician fee schedule, the 2024 physician fee schedule proposed rule is aimed at fostering a more equitable healthcare system. Effective implementation of the proposed policy changes will elevate the level of patient care.  

Let’s uncover the basics of PFS and what the physician fee schedule final rule 2023 addresses.

Understanding PFS Basics

The world of healthcare finance is filled with intricacies, and the physician fee schedule is one of its cornerstones that every provider must understand thoroughly.

Simply put, a physician fee schedule is defined as a list of fees assigned to different services and procedures healthcare professionals render to patients. These lists are used by insurance providers and Medicare to reimburse physicians and other healthcare providers.

Physicians provide services in various healthcare settings, including hospitals, physicians’ offices, hospices, outpatient dialysis facilities, and clinical laboratories. PFS ensures that the payment rates remain consistent across all healthcare settings.

On the other hand, some payers also use the MPFS (Medicare Physician Fee Schedule) as a reference for reimbursing doctors. The MPFS is an annual rule that specifically outlines and updates reimbursement rates for services doctors render to Medicare beneficiaries.

According to the medicare physician’s fee schedule, procedures are assigned relative value by factoring in relevant practice expenses, liability insurance, and the physician’s work. This value is then multiplied by a conversion factor to derive payment rates.

To account for any regional variations in the cost of operating a practice, further adjustment to the derived value can be made using GPCI (geographic practice code index).

For an accurate reflection of the costs associated with a physician’s work and the technical resources utilized to perform a procedure or service, the professional and technical components of a service can be segregated.

For instance, the professional component of a service indicates activities such as evaluation of a patient, diagnosis, etc, and this component is billed by the assigned physician.

On the other hand, the technical component of a service signifies the use of facilities and equipment to perform technical aspects of a service such as a laboratory test or imaging. Technical components are typically billed by suppliers such as dialysis facilities, radiology centers, and ambulatory surgical centers.

Role of PFS In Medical Billing

The physician fee schedule holds great significance in the world of medical and physician billing, influencing how procedures and services are translated into proper codes, billed by suppliers and practitioners, and reimbursed by payers. 

PFS provides a standardized framework for medical services’ reimbursement, contributing to billing transparency. This transparency allows payers to assess the validity of billed charges and for practitioners to comprehend reimbursement rates across different healthcare settings and different types of services.

PFS Payment Rates

The physician fee schedule is typically updated annually, and specific payment rates in PFS can vary depending on various factors, including updates made by CMS, geographical location of practice, and the types of services rendered.

However, there is a standard formula used to determine payment for a service, which is:

Work RVU (relative value units) x Work GPCI (geographic price cost index) + PE (practice expense) RVU x PE GPCI + MP (malpractice) RVU x MP GPCI = Total RVU x CF (conversion factor) = Payment. 

Providers can use the medicare physician fee schedule lookup tool to get further insights on billing, coding, and payment rates.

Medicare Physician Fee Schedule Proposed Rule 2024

Here is what you should know about the 2024 medicare physician fee schedule final rule.

  1. Compared to the conversion rate of $33.58 in the CMS physician fee schedule 2022 and $33.06 in the 2023 medicare physician fee schedule final rule, the final CY 2024 PFS conversion factor was reduced by 1.15% to $32.74.
  2. In the CY 2024 proposed physician fee schedule, the overall rates will be subject to a reduction of 1.25%. 
  3. CMS has also finalized reimbursement for providers who train other caregivers to assist patients diagnosed with specific illnesses. Payments will be provided as a part of the patient’s individualized treatment plan. 
  4. Effective January 1st, 2024, an additional payment for the new add=on HCPCS code G2211 will be introduced. 
  5. CMS has also finalized the definition for the phrase “substantive portion” used specifically for split/shared E/M visits. The substantive portion now signifies a key element of medical decision-making and more than half of the total time the physician or non-physician practitioner spends performing the split/shared E/M visit. 
  6. On a temporary basis, health and well-being coaching services are being added to the Medicare Telehealth Services list for CY 2024. 
  7. The implementation of the Appropriate Use Criteria (AUC) program has been temporarily put on hold by CMS.
  8. The 2024 PFS final rule also implements notable changes to the Medicare Shared Savings Program (MSSP).


What is the difference between FFS and PFS? 

    FFS (fee-for-service) is more of a traditional payment model where providers are reimbursed for each service they render. On the other hand, PFS is a component of FFS in which payment rates are based on relative values. 

    What are the definitions for facility and non-facility for the physician fee schedule? 

    Facility and non-facility both refer to different payment settings. For instance, a non-facility rate is used for services rendered in non-facility settings like a physician’s office, and facility rates are used for services rendered in hospitals and other healthcare facilities.


    Patient Demographics Documentation Guidelines

    Posted on November 27th, 2023 / Under Medical Billing / With No Comments

    When a patient enters a healthcare facility to acquire treatment, one of the first things the staff does is collect the patient’s information. That information is called patient demographics.

    Sounds straightforward enough, right? Only patient demographics have much more depth to it than just supporting physicians in providing high-quality care. 

    Patient demographics serve a multifaceted role, addressing several concerns, one of which is payment collection. Demographic data not only informs treatment plans but also ensures billing accuracy. 

    Lack of accuracy in patient demographic collection can lead to increased cost and duplicate testing, according to AHIMA medical coding and patient demographic standards

    To ensure a smoother medical billing process, let’s dive into what’s included in patient demographics and why it is important.

    What Do Patient Demographics Include?

    An accurate and complete patient demographic form typically includes all the information that’s required to streamline the medical billing process. Patient demographics can include but are not limited to the following: 

    1. The full legal name of the patient. 
    2. Date of birth.
    3. Gender of the patient.
    4. Address and contact information such as phone number and email address. 
    5. Social security number for insurance and billing purposes. 
    6. Insurance information such as policy number, insurance coverage, and name of provider. 
    7. Guarantor information for patients who are minors. 
    8. Emergency contact information.
    9. Ethnicity and race.
    10. Marital status.
    11. Language preference to facilitate effective communication between the patient and the provider. 
    12. Employment status, which can be relevant to insurance information.

    Some healthcare providers may consider medical histories such as family medical history, present medical condition, drug or other allergies, and surgical history as non-demographic data and include it only in the patient medical chart, while others may include it in the demographic sheet. 

    Collecting Patient Demographics Data 

    Patient demographics are collected during the registration process and are generally digital. Healthcare facilities use EHR systems to capture and store patient demographic data. 

    Patient demographic forms are also updated and secured through patient portals. The CDI medical process is further implemented by a clinical documentation improvement (CDI) specialist to ensure the accuracy of clinical data.  

    While this data can be collected in multiple ways, the patient demographic sheet has to meet specific standards, such as being HIPAA-friendly. 

    If healthcare entities are taking a verbal approach, they should avoid using jargon that could confuse the patients and impact data accuracy. Healthcare professionals should also assure patients that their demographic data will be kept confidential. 

    While many EHRs are already configured to collect medical documentation, some practices have untrained staff that may not know how to work the system properly, resulting in missing or incomplete patient information. 

    According to the CMS Medical Record Documentation Guidelines 2022, insufficient medical documentation can allow the reviewer to reject claims, concluding that the billed services were either not provided or were not medically necessary. 

    The key to a successful collection of patient demographic information is for physicians to train their staff on how to effectively use EHR systems. Having a standard collection process and using advanced software can streamline the process of collecting patient demographics.  

    Importance of Patient Demographics 

    Here is why patient demographics are important. 

    Streamlined Medical Billing Process

    One thing that consistently serves as a factor for claim denials is inaccurate and missing patient data. Patient demographic information directly impacts medical billing as it includes some critical information, including whether to bill the primary or secondary insurance provider for the services rendered to the patient. 

    Without gathering patient demographics, the billing procedure can be significantly delayed. For instance, without collecting such data, it can be difficult to confirm whether a patient without health coverage is eligible to be covered under the charity care program. 

    Cultural Competence

    Patient demographics data such as race, gender, and age can assist you in creating individualized treatment plans for specific patient populations.

    It’s essential to improve the cultural competence of your healthcare staff to make your practice an inclusive place where patients from all backgrounds can receive exceptional care. 

    An in-depth understanding of your patient’s history and cultural background will allow you to provide more personalized treatment to your patients. 

    Improving Patient Care

    Assessing the details of the patient demographics can help you improve patient care by determining risk factors and prescribing effective treatment. Knowing the patient’s medical history will allow physicians to tailor treatment plans to their specific conditions, improving the level of care provided. 

    Gateway to Effective Patient Communications

    One of the benefits of patient demographics is seamless communication between patients and providers. Many healthcare practices offer online portals to help patients update demographic information, such as their contact information, which may change over time.

    This leads to a reduction in missed or canceled doctor’s appointments as patients can be reminded effectively. Doctors can also interact with patients better, ensuring they stick to their treatment plans.


    What are some things to keep in mind for patient demographics? 

    One thing you should keep in mind when managing patient demographics is that accuracy is paramount. Ensure that you collect all personal details precisely and address diversity and cultural sensitivity in your practice. Safeguard patient privacy and ensure regular updates on medical records to reflect any changes in treatment. 

    Where does HIPAA factor in?

    HIPAA (Health Insurance Portability and Accountability Act) ensures the security and confidentiality of patient information, emphasizing the privacy rights of patients. All healthcare practices are required to comply with HIPAA standards to safeguard against unauthorized access to sensitive patient information.


    A Comprehensive Guide to Telehealth Billing 2023

    Posted on October 27th, 2023 / Under Medical Billing / With No Comments

    COVID-19 has brought multiple changes into our daily lives; one of those changes is a growing number of people opting for telehealth. Compared to 2019, when only 10% of people actively acquired telehealth services, a recent survey shows that approximately 52% of adults use telemedicine.

    Post-pandemic, there was a surge in demand for telehealth services because many patients deem it a more convenient option than in-person visits. Now, approximately 76% of healthcare organizations in the U.S. allow patients to consult with providers virtually. 

    Telemedicine is significantly different today from what it was pre-pandemic. Even the recent legislation by the U.S. Department of Health and Human Services authorized multiple changes, some of which are permanent.
    In this guide, we’ll help you navigate medicare telehealth billing guidelines 2023, including updated telehealth CPT codes, telemedicine modifiers, and reimbursement for telehealth.

    Telemedicine is significantly different today from what it was pre-pandemic. Even the recent legislation by the U.S. Department of Health and Human Services authorized multiple changes, some of which are permanent.
    In this guide, we’ll help you navigate medicare telehealth billing guidelines 2023, including updated telehealth CPT codes, telemedicine modifiers, and reimbursement for telehealth.

    What Is Telehealth? 

    Telehealth, also known as telemedicine, is a term used to describe the use of telecommunication and electronic information to address health needs. Common technologies to extend care include streaming media, wireless communications, and video conferencing. Telemedicine billing services can vary depending on your geographic location and the insurance provider or payer you are billing.

    Benefits of Using Telehealth

    One main reason people were using telehealth during COVID-19 is because it eliminated the travel burden for patients who were vulnerable to the virus. Other than that, telehealth provides multiple benefits, including,

    1. Vital details of a patient’s health can reach their assigned caretakers and healthcare team in time with the help of health monitoring services. 
    2. People struggling with poor mental health can seek online therapy services. 
    3. You can partner with telepharmacy services to deliver prescriptions to your patient’s doorstep. 
    4. With telehealth, uninsured patients are billed by providers at a price similar to a normal insurance copay, expanding their access to healthcare services. 

    Getting Reimbursed for Telehealth

    One common query most providers have is how they will get reimbursement for telehealth. The answer is that reimbursement rates for telehealth can vary due to laws such as the Pay Parity Laws and whether the qualified healthcare professional is receiving reimbursement from a private payer, Medicaid plan, or Medicare.
    For instance, if you live in one of the states that follow the pay parity laws, you will get reimbursement for telehealth similar to the reimbursement you get for in-person visits for the respective service.

    Telehealth Billing Guidelines 2023

    Telehealth Modifier 93 

    Generally, all telehealth sessions, except audio-only sessions, are billed using the modifier 95 or the GT modifier, varying depending on the payer billed for the services. Modifier 95 description includes the CPT code modifier used to bill telehealth services with the place of service code 11, which indicates an office. The place of service code 11 is the same code used when services are rendered in person. 

    Modifier 93 is a new CPT code modifier that came into effect at the start of 2022. This modifier describes a real-time interaction between a patient and a qualified healthcare professional located at different sites. It is essential for healthcare providers to bill all audio-only telehealth services using this modifier. 

    Temporary Changes In Medicare Telehealth 2023

    The changes made in the COVID-19 Public Health Emergency (PHE) were initially meant to be temporary, but the bill passed at the end of last year caused these temporary changes in telehealth billing guidelines to be extended through December 31, 2024.

    Two temporary changes that ended back in May included telehealth being provided as an exceptional benefit and Medicare-covered providers not being subject to a federal penalty for using applications that aren’t HIPAA-complaint to communicate with their patients.

    The changes that will extended through December 2024 are:

    1. Mental health and non-behavioral services can be obtained at any site. Originating site geographic restrictions for these services are waived.
    2. Some mental health and non-behavioral services can be delivered through audio-only communication.
    3. In-person visits within the first six months of initial non-behavioral and mental health service are also not required. The effective date of this rule was postponed for 151 days after the PHE, which ended in May.
    4. Occupational therapists, pathologists, audiologists, and physical therapists are now considered practitioners who can provide care using telehealth.

    Permanent Medicare Telehealth Changes 

    The focus of the majority of permanent changes made by the CMS (Centers for Medicare and Medicaid) is on mental health care. These include: 

    1. RHCs (Rural Health Clinics) and FQHCs (Federally Qualified Healthcare Centers) can be distant site providers for non-behavioral and mental health services. 
    2. One of the eligible originating sites for telemedicine services is REH (Rural Emergency Hospital). 
    3. Practitioners will no longer receive separate reimbursement for audio-only E/M services. 
    4. Virtual Direct Supervision is set to continue only until the end of 2023 and will not remain a permanent feature of Medicare. 
    5. Although CMS suggested five new codes to be added permanently to the Medicare Telehealth Services list, only three codes for chronic pain management and prolonged E/M services are made permanent as they are sufficiently similar to other services listed currently on a Category 1 basis. 


    How to bill for telemedicine?

    To bill for telemedicine, you must first determine the usage and type of telemedicine you offer, check any reimbursement and compliance policies appertaining to your claim, perform accurate coding using modifier 95 or GT depending on the payer, and finally add any CPT codes applicable to the telehealth services rendered. 

    Is telehealth covered by insurance in 2023?

    Other than Medicare and Medicaid, telemedicine services are covered by most private health insurance plans. However, depending on the state you belong to and the insurance carrier’s policies, reimbursement rates and telehealth coverage may vary. Telehealth services can be rendered through online consultations, audio, or video, so it is best to check in with the payer on what they cover and get a clear idea of the billing requirements. 

    Does Medicare cover telehealth?

    Typically, telehealth services are covered under Medicare Part B, which has a deductible of $226 in 2023. So, after a patient meets the part B deductible, they only pay 20% of the total Medicare-approved amount to their assigned physician or healthcare provider for the services rendered. 


    Medical Coding Audits: What You Need to Know to Stay Compliant

    Posted on October 23rd, 2023 / Under Medical Billing / With No Comments

    Effective management of healthcare information is incomplete without medical coding. Coding audits are a critical practice performed by a clinical coding auditor to ensure the practice has proper procedures set in place to achieve medical coding compliance. 

    Centers for Medicare and Medicaid Services (CMS)and the Office of the Inspector General (OIG) recommend healthcare organizations obtain an unbiased evaluation of their coding practices. This helps providers identify and eliminate errors in medical coding, maintain regulatory compliance, and expedite the reimbursement process. 

    Keep reading to learn about how medical coding audits can help you avoid major pitfalls stemming from coding errors. 

    Importance of Medical Coding Audits

    Coding reviews include examining the medical records of the patients to ensure the provider has selected and entered correct and comprehensive diagnosis and procedure codes. 

    medical records audit generally includes an examination of documentation to ensure it is accurate and complete, reviewing CPT codes, checking the location of patient care, ensuring the modifiers are not absent or incorrect, any absence or presence of any bundling concerns, and a medical coding utilization review. 

    Research shows that around 80% of medical bills contain some type of coding and billing errors, costing patients an extravagant amount of money compared to the level of service obtained. Other consequences of not conducting regular coding audits include damage to your practice’s reputation, lost revenue, and compliance risks. 

    Medical coding audits can help you uncover any current problematic trends in your practice, including upcoding, outdated coding, unbundling, and downcoding. For instance, multiple issues can affect medical coding accuracy, such as a lack of documentation. A general rule of thumb is medical coders are only able to use the documentation they are provided, so if a healthcare provider records documentation with missing details, it will lead to medical coding errors. Such errors can be identified through regular coding audits. 

    Another important reason for organizations to conduct these audits is compliance. Coding and billing practices are required to be in compliance with multiple regulations, including private payer policies, CMS, and OIG regulations. This puts the organization at risk of facing legal repercussions. 

    Benefits of Regular Medical Coding Audits for a Healthcare Practice

    Reduction in Claim Denial

    One common reason why most medical claims get denied at the initial stages is coding errors. Some common issues uncovered during these audits include any wrong diagnosis or procedure codes and insufficient documentation. With proper coding audit policy and procedure, coding errors are minimized. This reduces the risk of medical claims getting denied or rejected by the payer’s insurance provider. 

    Revenue Protection

    Coding mistakes are one of the major reasons why healthcare practices incur financial loss. For instance, if a claim is under-coded, there are still chances of it getting processed by the payer; this results in practice losing money by getting reimbursed for less than the actual level of services rendered. On the other hand, over-coded claims put the practice at potential risk of a regulatory fine. 

    Moreover, coding mistakes discovered during claims processing can cause the payer to deem the claim unpayable. This results in healthcare providers investing extra time and effort into fixing coding mistakes and resubmitting claims. However, with effective medical coding audit software, potential issues can be identified early in the process, helping your organization avoid such revenue loss.

    Fraud Reduction

    Another reason why periodic medical coding audits are essential is compliance issues and billing fraud. Medical coding audit documents allow organizations to identify any improper billing practices, such as invoicing for services not acquired by the patient or unnecessary services, and help uncover whether such issues were caused through intention or coding error. This allows healthcare organizations to take action and have their staff follow proper billing protocols to eliminate billing fraud. 

    Coding Accuracy Improvement

    The acceptable coding accuracy rate is 95%, and research shows that medical coding accuracy actually falls way beneath this standard. Coding accuracy impacts your risk judgment and quality of reporting. One major factor that affects coding quality is missing or incorrect documentation, which can easily be identified through coding audits. 

    Educating Your Staff

    One of the many benefits of coding audits is medical coding training. These audits allow your staff to improve as a team and ensure that your coders have proper training. 

    For example, outpatient coding audits will allow your coding team to develop a comprehensive understanding of the CPT system and get informed of the updated regulations. Inpatient coding audits allow coders to recognize changes in AHA (American Hospital Association) guidelines and ICD codes. This way, your coding staff will acquire all the necessary skills required to ensure coding accuracy. 

    Preventing Payer Audits:

    It is possible for your practice to get flagged for investigation by a payer if coding issues become persistent. The purpose of this investigation is to identify potential coding and billing fraud in practice, which, if found, can lead to financial consequences, including hefty fines. Regular audits can help you avoid any payer investigations for waste, abuse, or billing fraud. 

    Internal and External Coding Audits

    Generally, a member of the healthcare staff is employed by the organization to conduct an internal coding audit. This could be the auditing team members in large facilities and a clinical coding auditor in smaller organizations. 

    Internal coding audits help organizations identify areas of improvement and assess coding accuracy. While it is recommended to conduct regular internal coding audits, the actual frequency of these audits can vary depending on the size of a practice and its available resources. 

    External coding audits, on the other hand, are conducted by third-party auditing companies or government companies like OIG and are relatively more objective. These audits can take place biannually or even annually in some organizations. 

    External coding audits play a vital role in identifying recurrent coding errors and fraudulent coding practices within the organization. These audits have more value than internal audits as they are performed by an independent party. 

    Coding audits, whether external or internal, are essential if your organization wants to maintain medical coding integrity, prevent fraudulent activities, and avoid potential pitfalls.


    Latest Changes and Updates In Healthcare Billing Regulations 2023

    Posted on October 13th, 2023 / Under Medical Billing / With No Comments

    In 2023, similar to previous years, medical billing and coding regulations have been updated. While some of these 2023 medical billing updates are easy to accommodate, others have been reported to need to be more precise and more manageable for healthcare workers.  

    Even the smallest updates, like the changes with the QPP (Medicare’s Quality Payment Program), are noteworthy. The coding and billing guidelines are modified each year to elevate the quality of services rendered and patient care. 

    It is crucial for your healthcare staff to stay on top of these updates to avoid potential claim denials, lawsuits, delayed reimbursement, and fraud. Read on to learn about the 2023 billing and coding updates and how optimizing them will help your practice.

    Updated Medicare Payment Policy

    As for updates on physician billing, the original decrease in the conversion factor was a 4.5% reduction to the Medicare Physician’s Fee Schedule payments which was opposed by the majority of physicians. 

    So, after groups in the healthcare industry counteracted this decrease in conversion rates by joining hands and asking Congress to lower them, Congress decided to lower the reduction to 2% in 2023, increasing it again to around 3.5% in the coming year, 2024, considering the financial challenges faced by healthcare providers during the pandemic. 

    There was also a split-shared visits policy finalized in 2022 by the Centers for Medicare and Medicaid Services(CMS) which was delayed after around 20 physician organizations wrote to CMS, citing their concerns on how the implementation of this policy would negatively impact patient experience and any collaborative care delivery models. According to this policy, in 2024 any shared/split visits are to be billed under the National Provider Identifier (NPI) of the individual who provides a total visit time of more than 50%. For instance, if a physician and an NPP both provide care to the patient, provided that a substantive portion of the physician’s assistant’s time is spent caring for the patient, then the visit will be billed under the NPP’s National Provider Identifier. This leaves the practice with only a Physician Fee Schedule Rate of 85%. Whereas, in 2022, visits shared between a physician and an APP were billed under the NPI of any non-physician practitioner or physician who either provided more than 50% of the total service time or documented the support for medical decision-making, exam, and history.

    Modifier JZ 2023

    On January 1, 2023, a new modifier known as the Modifier JZ, announced by the Internal Revenue Service (IRS) came into effect. The purpose of this modifier was to streamline the reporting of any services provided in hospital or outpatient settings. 

    The JZ Modifier is reported on the same line as the CPT code for a service it is applied to. It offers more clarity for medical claim processing and allows better tracking of services provided in outpatient settings or hospitals. For instance, if a patient received a service or supply at a waived or reduced rate because they are eligible for a government program like Medicare or Medicaid, the JZ Modifier will be applied to the CPT code of the services provided. 

    It is one of the critical medical billing updates of 2023 which healthcare providers must familiarize themselves with if they want to receive timely reimbursement.

    JG Modifier

    CMS proposed that starting from January 1, 2o23 the JG Modifier will be used for identifying the 340B drugs. Hospitals like children’s hospitals, PPS (Prospective Payment System) exempt cancer hospitals, and rural sole community hospitals will continue to use the TB modifier for similar purposes and any other hospitals will be using the JG modifier. 

    That is because the JW modifier is one of the modifiers for medical billing required to be applicable when billing the waste of 304B drugs. Other appropriate modifiers in medical coding for 340B drugs like the JG modifier should be used by eligible healthcare facilities.

    Codes for Biosimilars

    In the 2023 CPT/HCPCS code set release, CMS has included new drug code biosimilars which are FDA-approved medications. These medications are similar to other biological drugs in dosage, usage, efficacy, and potential side effects but they cost relatively less. 

    CMS is reported to reimburse the biosimilars with an ASP equal to or less than ASP 8% which is the reference biological price. This is done to drive down drug costs and boost the production of biosimilars. 

    Considering that the reference biological reimbursement is APS 6%, the 2% increase for biosimilar drugs is a step forward to a greater impact on patient care. This increase started back in October 2022 and is set to continue for up to five years.


    1. What are the changes in CPT coding for 2023?

    CPT codes have gone through multiple changes in 2023, including: 

    • 93 revised codes and 75 CPT codes were deleted. 
    • Changes to the evaluation and management (E/M) codes and Covid-19 vaccination codes. 
    • Except for anesthesia, all departments of the CPT 2023 code set were recorded to have coding and guideline changes. 
    1. What are the ICD 10 changes for 2023?

    The ICD-10 changes for 2023 include several terms being modified, 251 codes being deleted, and 36 ICD-10 codes being converted into parent codes. There are around 1176 new billable ICD-10 codes in 2023, among which some major changes are recorded in endometriosis, motorcycle accidents, head injuries, maternal care for fetal disorders, and dementia. 

    1. Can you bill for a PA under the supervising physician?

    It can depend on payer requirements. For instance, some payers can enroll or credential PAs while others can require any services rendered by the PA to be billed under the National Provider Identifier (NPI) of their supervising physician. 

    1. How many CPT codes are there in 2023?

    The CPT code set for 2023 has 10,696 codes, describing services and medical procedures that are available to patients. This set includes at least 93 revisions, 75 deleted codes, and the addition of 225 new codes. The CPT code set will further evolve with growing innovation. 


    What Is Claim Adjudication? A Critical Phrase In Medical Billing

    Posted on October 10th, 2023 / Under Medical Billing / With No Comments

    The process of submitting a patient’s claim to their insurance provider and receiving reimbursement after the provider performs a manual review of it may appear straightforward, but it’s not that simple.

    There’s significant information, billing codes, clinical data, and much more involved in the claims submission process that makes it complicated. Every medical claim, whether it gets accepted or denied, undergoes adjudication once received by the insurance provider.

    Although, as a healthcare professional, you might not have much control over how the adjudication process unfolds after claim submissions, you can keep reading to gain insights that increase your chances of getting quick reimbursement for the next claim submitted by your organization.

    Here is what you should know about adjudication in medical billing.

    Adjudication Process In Medical Billing

    The claim adjudication process in medical billing is when the insurance payer reviews a claim submitted by the healthcare organization and determines the extent of their responsibility to pay for the medical services by comparing the claim to any benefit requirements, reference files, or coverage.

    Doing so enables them to adjust the amount they will pay to the healthcare provider if required. The adjudication process could also lead to a significant reduction of the billed amount or denial of the claim altogether. For example, if a claim is invalid or contains billing and coding errors, the payer has the authority to deny paying for it. The overall adjudication process involves five steps:

    1.     The Initial Processing Review

    Did you know that the majority of medical claims submitted to insurance companies are denied at the initial stage of the adjudication process? The reason behind this is claims are reviewed initially to detect simple errors including, grammatical mistakes, spelling errors, incorrect place or date of service code, invalid diagnosis code, and incorrect subscriber identification number. At this stage, the healthcare provider can recheck a denied claim, make necessary amendments, and resubmit it. While denials may not prevent the provider from resubmitting the claim, it does cost the organization resources and time. This is why many healthcare professionals now use all-inclusive medical billing services to minimize the risk of simple errors in claims.

    2.     Mass Adjudication or Automated Review

    The automated review of a claim is more detailed and complicated because the claim is checked against the payer’s payment policies, including any copayments, fee schedules, relevant contracts, and service groups. Patient eligibility, duplicate claims, unbundling, down coding, pre-certification issues, expired filing deadlines, and issues with the level of patient care are identified at this stage of the adjudication process.

    3.     Manual Review

    If a claim is tagged in edits and does not pass the automated review stage, it will be pending for the manual review, which is done by a medical claim examiner. At this stage, the medical claim examiner requests medical records to manually compare them with the claim. In some cases, a nurse or physician may also be involved, typically if there is an unlisted procedure.

    4.     Post Adjudication Process

    In some cases, even if claims do not get rejected throughout the adjudication process, the insurance payer may conduct secondary auditing of your claims. This ensures that the claims are in compliance with any state or federal regulations, coding combinations, editing, and other guidelines.

    5.     Payment Determination

    At this stage of the process, the payer determines whether the claim is reimbursable or not. They can also decide to downcode the billed amount to an appropriate level if it is too high and does not match the level of service provided or the final diagnosis.

    6.     Payment

    The payment provided by the payer after adjudicating a claim is either called the explanation of payment or remittance advice. That is because other than the funds, the payer also provides the healthcare facility with reasons for denial, reasons for the payment itself and any reduction, and details of uncovered charges.


    What Is Adjudication In Healthcare?

    Adjudication in healthcare is the process of insurance payers reviewing claims submitted by healthcare providers and comparing these claims with coverage requirements and other contracts to either pay or deny them. Some insurance providers process medical claims through software for adjudication purposes. This is also known as auto-adjudication.

    How Does Claim Adjudication Differ from Claim Submission?

    To get reimbursement for the services provided, healthcare professionals submit claims to the insurance providers of the patients. The process of gathering patient information and clinical data, coding the diagnosis and services rendered, and billing the insurance provider is known as claim submission. Whereas claim adjudication is the review of the medical claim performed by the insurance company through which it determines whether a claim is reimbursable or not.

    How Long Does the Claim Adjudication Process Typically Take?

    While there can be distinct circumstances surrounding every medical claim submitted, and each insurance payer’s adjudication process may also differ, typically a claim adjudication process can take up to two weeks before the insurance payer makes a decision to pay the claim in full, down code the billed amount, or deny the claim.

    What Is the Impact of Claim Adjudication On Healthcare Providers?

    Healthcare organizations utilize the data gathered from claim adjudication processes to accelerate their go-to marketing strategy and trace referral patterns. Claim adjudication system in medical billing also helps ensure that the medical claims are valid and accurate.

    What are the Five Steps In the Adjudication Process?

    The adjudication process in medical billing includes five steps: the initial processing review, the automated review where the claim is compared with policy documentation, a manual review performed by a medical claim examiner, payment determination, and payment.

    How Do Errors In Medical Billing Affect Claim Adjudication?

    Errors in medical billing can be identified in the initial stage of the process or after the automated or manual review is conducted, and these errors can cause payment delays, claim denials, and even lead to legal liabilities. Some common medical billing errors that affect adjudication include upcoding, downcoding, lack of documentation, and incorrect selection of the level of services rendered.


    Key Steps for a Successful Revenue Cycle Optimization Strategy

    Posted on August 4th, 2023 / Under Medical Billing / With No Comments

    In the healthcare industry, achieving revenue cycle optimization can be challenging as it involves many parts, such as charge capture, registration, patient collections, remittance processing, insurance claim follow-ups, and other billing and coding practices. 

    To mitigate losses, hospitals and health systems must keep all departments within the organization updated regarding the current industry trends and compliance requirements, as the performance of every department impacts the healthcare revenue cycle optimization. 

    A practice must invest efforts to optimize revenue cycle management to avoid ending up dealing with delayed reimbursement and inevitably having to rely on cash reserves to sustain operations. By taking some key steps, including using revenue cycle management services and streamlining the patient billing process, your practice can achieve successful revenue cycle management optimization.

    Automating the Components of the Revenue Cycle

    To improve your practice’s financial performance, you should automate different components of its revenue cycle. You can significantly reduce the administrative burden on healthcare providers by using automated analytic and reporting tools that allow you to gain data insights and capture accurate data in real-time.   

    For instance, there are many time-consuming tasks healthcare workers perform to obtain timely reimbursement, such as following up on the claim status and verifying patient eligibility. Using advanced automated software will allow workers to focus on other valuable tasks. Automation would help your organization greatly cut down on labor costs and reduce errors in coding and billing.  

    If there is an existing technology infrastructure, try identifying any gaps that are hindering the revenue cycle. Invest in a robust software solution that meets the requirements of your organization, provides data security, allows you to stay compliant with industry trends, and integrates efficiently with the existing systems.

    Improve Front and Back-end Collaboration

    Typically, healthcare providers segment the revenue cycle management between the front-end and back-end staff of the hospital. Still, this segmentation only leads to knowledge gaps, eventually affecting the overall revenue cycle. Although the front-end and back-end staff have distinct responsibilities, effective exchange of data and information results in fewer preventable errors, enhanced patient satisfaction, and streamlined operations. 

    Maintaining open channels of communication and promoting collaboration among the front and back-end staff is one of the healthcare revenue strategies that help optimize the revenue cycle. A seamless exchange of information between the clinical and administrative teams allows your practice to address any potential issues and overcome them with ease.

    Improving Price Transparency and Patient Engagement

    One of the key factors that drastically impact revenue cycle management is not providing transparent and clear billing information to the patients. Healthcare providers must give patients convenient payment options that accommodate the patient’s preferences and provide them with accurate price estimates. This will help improve collections as patients will better understand their financial responsibility. 

    You can also implement financial counseling programs for patients in your facility to help them understand the billing process and insurance coverage information and avail of any financial assistance options.  

    Encouraging patient engagement and fostering a culture in the facility with seamless communication between the patients and providers will facilitate revenue cycle optimization, allowing you to recover reimbursement faster.

    Tracking Healthcare Metrics and KPIs

    You cannot accomplish revenue cycle optimization without data-driven decision-making. One of the first steps you should take toward optimizing your revenue cycle management is using data analytics to discover any potential areas that require improvement and identify key performance indicators (KPIs).  

    Team leaders in your healthcare organization should review and choose between KPIs such as patient satisfaction rates, cancellation rates, collection rates, and denial rates wisely and target them to drive positive changes within the workflow. Presenting these data insights and KPIs to your clinical and non-clinical staff will motivate them to become more efficient in their duties.

    Improve Denial Management Process

    When looking to optimize your practice’s revenue cycle management, you should improve the denials management and appeals process. Recurring issues in medical claims are one leading cause of why providers are denied reimbursement. 

    But, if you implement a denial management process where each claim denial can be systematically investigated for error patterns and appealed in a timely manner. You can significantly reduce these denials and optimize the revenue cycle.

    Outsource Medical Billing

    Medical billing is one of the biggest administrative burdens your healthcare providers have to deal with on top of delivering clinical services, which is why you should invest in outsourcing medical billing for revenue cycle management. Transferring the tasks of billing to healthcare revenue cycle management companies gives your staff more time to retain their full focus on delivering quality patient care, resulting in revenue cycle optimization. 

    Medical billing companies deploy effective revenue cycle management strategies so there are fewer risks of errors in the billing process, payments are made faster, and the revenue cycle management is improved.


    What Is Revenue Cycle Management In Medical Billing?

    In medical billing, revenue cycle management is defined as optimizing the financial journey of the patient from the beginning when their appointment is scheduled to when the payment is collected by the provider. The revenue cycle management process involves medical coding and billing, submitting claims to insurance providers, appealing denied claims, and collecting reimbursement from payers.

    Why Is Revenue Cycle Management Important?

    Revenue cycle management is essential because it enhances patient satisfaction, maximizes the revenue of your practice, helps you stay on top of current healthcare industry trends, and improves cash flow. 

    What Are Some Strategies to Improve the Revenue Cycle?

    Some of the best revenue cycle management strategies include implementing accurate processes for verifying patient eligibility and registration, providing financial counseling to patients, monitoring KPIs to minimize errors, implementing denial management protocols, streamlining claims process follow-ups and timely submissions, optimizing coding practices, promoting transparent billing, and efficiently negotiating payer contracts. 

    What Can Hospitals Do to Increase Revenue? 

    A hospital’s revenue cycle can be optimized by negotiating better contracts with payers, improving marketing strategies to increase patient volume, and exploring potential partnerships that can help expand revenue streams.


    A Closer Look at Common Medical Billing Errors

    Posted on July 31st, 2023 / Under Medical Billing / With No Comments

    Medical billers and coders deal with thousands of codes when documenting procedures and other relevant treatments provided to patients, making medical billing errors inevitable in some cases. However, when these errors occur, they can impact the claims process, leading to denied claims or delayed reimbursement, resulting in a loss of revenue.

    Typically, errors in medical billing occur due to basic mistakes made during the entire billing process, such as miscoding or misreporting. Understanding the reasons behind the most common medical billing errors can help minimize them, optimize the revenue cycle, and keep your patients satisfied.

    Common Medical Billing Errors:

    Duplicate Billing:

    Duplicate billing is a common medical billing error that occurs when a patient gets billed more than once for the same procedure. This type of billing can be a mistake or can be done intentionally, which is also known as medical billing fraud.

    For instance, if you have to repeat a procedure on the same day and there is a modifier misuse, such as not using modifier 76 in the bill, it will result in a duplicate billing mistake. Frequent duplicate billing can lead to rejected claims and negatively impact the facility’s reputation.


    Undercoding is another common error in medical billing, resulting in the codes added to the bill not fully reflecting the extent of services provided to the patient. The National Correct Coding Initiative necessitates that physicians must always use the CPT/HCPCS codes that accurately describe the services rendered rather than reporting less comprehensive codes.

    This error typically occurs due to miscoding or if the provider is trying to avoid a denial or an audit. It’s crucial to prevent underbilling a patient in any situation, even if done as a sympathetic act towards a financially struggling patient, as it can lead to fraud charges and revenue loss.


    Unbundling is when a provider does not use a comprehensive code to bill a single procedure and instead uses separate CPT codes for it, resulting in overbilling the patient. Medical billing errors such as unbundling can be tricky to identify. If fragmenting billing codes is done intentionally to increase reimbursements from Medicaid or Medicare, it would be considered fraud and lead to legal repercussions.

    Missed Deadlines:

    Most insurance companies have strict deadlines for filing a claim, and some deadlines can be as stringent as 30 days. There can also be a limited timeline to follow up with claims and correct any billing errors. If a claim is denied because it was not filed on time, it can make the process of appealing the denial more complicated. To expedite the reimbursement process, ensure that you do not miss the deadline for filing medical claims.

    Insurance Verification Issues:

    One of the biggest reasons most medical claims are denied is insurance verification issues. This issue often stems from overreliance on pre-existing information and routine.

    For example, suppose a patient frequently visits a facility to acquire treatment. In that case, the providers or staff can presume that their insurance information has not changed and fail to verify their eligibility. This can cause multiple issues, including the Coordination of Benefits (COB) error, which occurs when the patient has more than one insurance provider.

    Missing or Incorrect Documentation:

    Even the most basic errors, such as spelling mistakes or adding the wrong patient ID number into the medical billing software, can leave you with correcting patient information and resubmitting claims after denials. Missing or incorrect information, such as patient, provider, or insurance information, is one of the most common medical billing errors.

    Ways to Prevent Medical Billing Errors:

    Here are some ways you can prevent errors in medical billing:

    1. Update Your Practice’s Fee Schedule: Working on the existing fee schedule can cause your practice to suffer revenue loss, as reimbursement rates may vary when working with different insurance providers. Update the fee schedule to avoid any discrepancies.
    2. Implement EDI: Implementing electronic data interchange (EDI) will streamline the billing process by reducing the amount of time it takes a bill to be processed and improving accuracy in medical billing.
    3. Accounts Receivable Analysis: Accounts Receivable (AR) analysis will help you recover any overdue payments and conduct follow-up procedures to resolve denied claims.
    4. Double-Check Forms Before Filing Claims: Double-checking all forms to ensure the patient, insurance, and provider information is correct before you proceed to file a claim can save you from the headache of dealing with delayed payments and denied claims.
    5. Medical Billing Audits: Compliance issues and fraudulent claims can be avoided through medical billing audits. It will also improve collaboration among the team, enhance patient care, and help you identify improper billing practices and coding errors.


    How do coding errors impact the billing process, and how can they be avoided?

    Incorrect coding can lead to several problems, including fractional or delayed payments, increasing the claim processing timeline, instigating audits by the insurance company, and increasing the possibility of fraud charges. Coding errors can be avoided by training staff to stay updated with current coding requirements, ensure precise documentation, and improve staff collaboration.

    What are some effective denial management strategies to prevent revenue loss?

    By identifying core reasons for claim denials, implementing modern technology to address the issue of miscoding, training the staff to avoid billing errors, and regularly performing audits, you can minimize the risk of revenue loss in your healthcare facility.

    How can advancements in technology and software improve billing accuracy?

    Automating the coding process can minimize errors that would otherwise occur through manual coding, such as underbilling or overbilling. The use of technology such as electronic health records (EHRs) has significantly improved billing accuracy by streamlining data entry.

    What is the role of medical billing audits in identifying and rectifying errors?

    Medical billing audits include systematically reviewing coding and billing practices, which helps improve the accuracy of the billing process by ensuring compliance, correcting billing mistakes, and identifying any discrepancies.


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