There are two main ways that insurance companies respond when they decide not to pay a claim, denial and rejection. Both indicate the claim will not be paid, but there are some important differences between the two. The distinction is critical for medical providers to correctly follow-up so they can get claims paid appropriately. Let’s […]
Claim Denial Rate, Claim Rejection Rate, Denial Management, Denial vs Rejection, Revenue Cycle Management
HL7 and FHIR are both standards developed by Health Level Seven International for exchanging healthcare data between software systems, but they represent different generations of the same effort. HL7 v2.x, the version most widely deployed today, was developed in the late 1980s to enable data exchange between hospital information systems using pipe-delimited message segments. FHIR, […]
Billing Automation, Interoperability, Message Exchange Patterns, RESTful API, RPA
In medical billing and coding, knowing Common Procedural Terminology (CPT) codes is essential. These codes act as a universal language, supporting smooth communication between healthcare providers and insurance entities. Let’s look at CPT codes, exploring their significance and shedding light on the most commonly used ones. Decoding CPT Codes: A Brief Overview Before we start […]
CPT Codes, Medical Billing, Medical Reimbursement, Revenue Cycle Management
Diagnostic testing for COVID-19 has become a cornerstone of pandemic response for healthcare providers. However, rolling out testing services presents immense challenges around reimbursement and revenue cycle management. This definitive use case walks through COVID-19 testing billing and coding procedures in 2022 step-by-step, using examples to illustrate how to optimize claims submission and payment across […]
COVID-19 Test Billing, CPT Codes, Revenue Cycle Management
Digital therapeutics (DTx) reimbursement is both a challenge and an opportunity for the healthcare industry. The healthcare industry is undergoing a digital transformation, with software-based therapeutic interventions known as digital therapeutics emerging as disruptive new modalities to prevent, manage, and treat a growing range of medical conditions. Digital Therapeutics Breakdown Digital therapeutics deliver evidence-based treatments […]
Digital Therapeutics Billing, DTx Billing, Reimbursement, Revenue Cycle Management
The healthcare industry has undergone a digital transformation in recent years, with virtual care technologies playing a central role. Virtual care refers to any health services provided remotely through telecommunications and digital technologies. These technologies are enabling more convenient, accessible and affordable healthcare delivery. For healthcare providers, understanding the virtual care environment is crucial to […]
Blockchain Technology, Hybrid Care Models, Telehealth, Telemedicine, Wearable Devices
CPT codes for telestroke and teleneurology billing depend on how care is delivered by telehealth. Telestroke and teleneurology refer to the use of telehealth to provide acute stroke care and neurological care from a distance. This allows neurologists and stroke specialists to evaluate and manage patients in hospitals or clinics that may not have specialty care […]
Telehealth Billing, Telemedicine Billing, Teleneurology Billing, Teleneurology CPT Codes, Telestroke Billing, Telestroke CPT Codes
Biologics and specialty drugs represent some of the most innovative and specialized pharmaceuticals available today. They are used to treat a wide range of diseases and conditions, from cancers to autoimmune disorders. However, these modern medications also come with high price tags and layered administration requirements. One of the tools used to properly bill and […]
Additional Injectable Drugs, Biologics and Specialty Drugs CPT Codes, Infusible Biologics, Injectable/Infusible Biologics, Interferons
Medical coding mistakes can cost a practice, because medical coding is a detail-oriented job. Even experienced coders can make mistakes that lead to costly errors and compliance issues. Avoiding common coding mistakes is crucial for accurate reimbursement, proper record-keeping, and avoiding penalties. Medical coding is highly detailed, yet accuracy is critical for proper reimbursement, compliance, […]
Common Coding Errors, E/M coding, Incorrect E/M, National Correct Coding Initiatives, Unbundling
Effective January 1, 2022, the Centers for Medicare & Medicaid Services (CMS) introduced four new HCPCS modifiers for Medicare claims (XE, XP, XS, and XU). These modifiers provide more specificity around the circumstances of service provided. Using these new modifiers correctly is essential for ensuring accurate reimbursement. We provide an overview of modifiers XE, XP, […]
Medicare Modifiers, Modifier XE, Modifier XP, Modifier XS, Modifier XU
Workers’ compensation provides benefits to employees who suffer job-related injuries or illnesses. It covers medical treatment, lost wages, and rehabilitation services. Workers’ comp is regulated at the state level and all businesses are required to have workers’ comp insurance. When an employee is injured on the job, they need to file a claim with their […]
Denied Workers’ Compensation Claims, Human Resources, Insurance Adjusters, Workers’ Comp Claim, Workers’ Compensation Billing
Modifier codes are an important part of medical billing and coding. They provide additional information about a medical procedure or service to help ensure proper reimbursement. Knowing when to use modifier codes can improve claim accuracy and prevent costly payment delays or denials. We explain what modifier codes are, why they are used, the most […]
Anatomic Modifiers, Bilateral Surgery Modifiers, Global Surgery Modifiers, Medical Coding, Procedure Modifiers
The difference between comprehensive, component, and modifier codes matters because medical billing and coding relies on different types of codes to accurately document procedures, services, diagnoses, and supplies. Three important types of codes are comprehensive codes, component codes, and modifier codes. Knowing the differences between these code types is crucial for accurate medical billing and […]
Adjunct Services, Bundling, Laterality, Modifier Codes, ModifiersImproper bundling in medical billing occurs when services that should be billed under a single CPT code are instead billed as separate component codes to generate higher reimbursement, a practice CMS classifies as unbundling. The inverse error, combining services that should be billed separately under a single code, results in underpayment and lost revenue. Both […]
Component Codes, Comprehensive Codes, Improper Bundling, Modifier Codes, Unbundling
Fixing common medical billing errors improves revenue, reduces denials, and supports compliance for healthcare providers. Frequent billing mistakes can hurt your medical practice’s bottom line. Discover the most common medical billing errors, their financial impact, and proven steps to prevent them. This extensive billing guide for providers, clinics, and medical billers will help fix errors […]
Diagnosis Code Errors, Incorrect Modifiers, Medical Billing Errors, Missing Pre-Authorizations, Procedure Code Mistakes
Medical billing automation uses software to handle the repetitive parts of the revenue cycle, such as eligibility checks, claim scrubbing, claim status follow-up, and payment posting, so billers spend their time on the claims that need judgment. Most practices already automate a little through their practice management system. The difference between a little and a […]
Artificial Intelligence, Billing Automation, Revenue Cycle Management, Robotic Process Automation
Oncology billing involves the use of many detailed CPT codes to accurately report services provided to cancer patients. Choosing the right codes is critical for ensuring proper reimbursement and compliance with billing guidelines. We provide an overview of the most common CPT codes used in oncology billing and coding. Evaluation and Management (E/M) Codes E/M […]
Chemotherapy CPT Codes, Nuclear Medicine Services, Oncology Billing, Oncology Coding Reimbursement, Oncology CPT Codes
Electronic health records (EHRs) have become an indispensable part of healthcare operations, which is why connecting an EHR to a clearinghouse matters. EHRs allow providers to store patient information electronically and share it securely. However, to transmit claims and other data to payers, providers need to connect their EHR system to a clearinghouse. A clearinghouse […]
Clearinghouse, EMR, HL7, Interoperability, Revenue Cycle Management
CPT codes for speech therapy billing cover services that are critical for evaluating and treating communication disorders, swallowing difficulties, and cognitive-linguistic impairments. However, selecting the proper CPT codes for speech therapy can be difficult given the many types of assessments, modalities, and interventions provided. We examine the most frequently used Current Procedural Terminology (CPT) codes […]
CPT Codes, Evaluation Codes, Medical Billing, Speech Billing, Speech Therapy Billing
The healthcare industry is facing a critical staffing shortage that is impacting medical billing operations and revenue cycle management. With an aging population and expanded access to healthcare, the demand for healthcare services is rising. However, there is a shortage of healthcare workers, including medical billers and coders, to meet this growing demand. This is […]
Medical Billing Staff, Outsourced Billing, RCM, Revenue Cycle Optimization, Robotic Process Automation