Navigating the medical billing and coding landscape demands meticulous attention to detail, as precision and accuracy play pivotal roles in securing appropriate reimbursement and upholding regulatory compliance. Among the various tools at a coder’s disposal, modifiers play a crucial role in accurately describing the circumstances under which services are provided. Medicare Modifier XU, in particular, […]
Biling Codes, CMS, Coding, coding and billing, Coding Intricacies, medicare, Medicare Modifier XU, Medicare Modifiers, Modifier Xu, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Precision and accuracy are paramount in the world of medical billing and coding. Modifiers play a crucial role in this landscape, allowing healthcare providers to add nuance and specificity to their claims. Among these, Medicare Modifier XP holds a unique position, particularly when it comes to reporting services performed by different practitioners. We’ve furnished a […]
Billing Codes, CMS, Coding, coding and billing, Coding Intricacies, medicare, Medicare Modifier XP, Medicare Modifiers, Modifier XP, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Precision is key to ensuring proper reimbursement and maintaining compliance. Among the various tools at a coder’s disposal, modifiers play a crucial role in accurately describing the circumstances under which services are provided. Medicare Modifier XS, in particular, holds significant importance when it comes to reporting procedures or services performed on different anatomic sites or […]
Billing Codes, CMS, Coding, coding and billing, Coding Intricacies, medicare, Medicare Modifier XS, Medicare Modifiers, Modifier XE, Modifier XP, Modifier XS, Modifier Xu, Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Accurate use of modifiers is crucial for proper reimbursement and compliance in the medical coding and billing industry. Among these, Medicare Modifier XE holds a significant place, particularly when it comes to reporting distinct and separate encounters on the same day. We provide a comprehensive understanding of Modifier XE, its appropriate use, and its impact […]
Billing Codes, CMS, Coding, coding and billing, Coding Intricacies, medicare, Medicare Modifier XE, Medicare Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
If you’re a healthcare provider or facility dealing with Medicare, one thing is certain – getting properly reimbursed is a maze filled with complex rules, convoluted paperwork, and often, sheer frustration. Medicare reimbursement is the lifeblood that keeps many healthcare operations afloat, but navigating its serpentine pathways can feel like a daily battle. Buckle up […]
APC, APCs, CMS, Geographical Practice Cost Index, healthcare, Healthcare Billing, Inpatient Prospective Payment System, IPPS, Medical, Medical Billing, medicare, medicare billing, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare Physician Fee Schedule, Medicare Reimbursement, Medicare Severity Diagnosis Related Groups, MIPS, MS-DRG, OPPS, Prospective Payment Systems, Revenue Cycle, Revenue Cycle Management
With nearly 30 million residents, Texas maintains the second largest state population in the country. This burgeoning community includes diverse urban metropolises like Dallas, Houston, San Antonio and Austin as well as remote rural towns and border communities. The variability in patient demographics and healthcare access models across Texas locations generates pronounced impacts on medical […]
Austin Medical Billing, Dallas Medical Billing, healthcare, Healthcare Billing, Houston Medical Billing, Medical, Medical Billing, Medical Billing Service, outsourced billing, outsourced medical billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, San Antonio Medical Billing, Texas Care Delivery, Texas Medical Billing
As US healthcare costs continue rising steeply – now over $4 trillion representing nearly 20% of GDP – both federal and state policymakers urgently seek ways to contain runaway expenditure growth. This drive manifests through expansion of programs like Medicare Advantage and Medicaid managed care coupled with accelerating passage of game-changing legislation like No Surprises […]
billing, Billing Best Practice, Billing Disruption, billing revenue, Claim Data, Consumer-Centered Billing, Good Faith Estimates, Health Level 7, healthcare, HL7, Interoperability, medicaid, Medical Billing Regulations, medicare, No Surprises Act, Pre-Authorization
At Medwave, we are dedicated to providing valuable insights and guidance on detecting and preventing healthcare fraud and abuse. We will equip you with the knowledge and tools necessary to safeguard your organization and patients from these malicious activities. By implementing the strategies outlined below, you can enhance the integrity of your healthcare services and […]
fraud, healthcare, Healthcare Abuse, Healthcare Fraud, medicaid, medicaid fraud, Medical, Medical Fraud, medicare, medicare fraud, Phantom billing
Proper Verification and Accreditation in Medical Credentialing The process of medical credentialing is crucial in ensuring the quality and safety of healthcare services. It involves verifying the credentials and qualifications of healthcare providers and evaluating their competency to provide medical services. We examine the importance of proper medical credentialing and how it benefits both healthcare […]
accreditation, Credentialing, education verification, healthcare credentialing, medicaid, medical credentialing, medicare, verification
Medicare and Medicaid Fraud is a Massive Healthcare Industry Problem Medicare and Medicaid Fraud Vulnerability The Medicare and Medicaid programs provide crucial support to millions of Americans, offering access to healthcare services for those who may not otherwise be able to afford it. Unfortunately, these programs are also vulnerable to fraud, with criminals exploiting the […]
Billing for services not rendered, billing fraud, False certification, fraud, Kickbacks, medicaid, medicaid fraud, medical billing fraud, medicare, medicare fraud, Phantom billing, Prescription drug fraud, Supply fraud, Unlawful self-referral, Upcoding, Whistleblower, Whistleblower Protection Act
What’s the Difference Between a Skilled Nursing Facility and a Nursing Home? On the surface, a skilled nursing facility and a nursing home may appear rather the same. In fact, some care facilities actually function as both, with a distinct floor or section of a building dedicated to each. The difference between a skilled nursing […]
billing, Medical Billing, Medical Billing Service, nursing billing, nursing facility billing, nursing hom, old folks home, skilled nursing, skilled nursing billing, skilled nursing facility, skilled nursing facility billing
Let’s begin with this set-up: Let’s say you’re hunting for a new job and receive a call from a would-be employer informing you that the job is yours. Of course, you’re thrilled by the news and inquire about your starting salary. Your new employer replies that you need to wait for your first paycheck to […]
Credentialing, healthcare credentialing, medicaid, medicare, private insurers, Provider Credentialing, provider networks, reimbursement rates
Home Health Services + Medicare What does Medicare Cover for Home Healthcare? If you’re looking for an answer to the question, “What does Medicare cover for home healthcare?”, you’ve probably typed it into a search engine and immediately closed the tab. The amount of information and the level of detail can quickly become confusing and […]
healthcare, healthcare services, home health care, home health services, home healthcare, medicaid, medicaid billing, medicaid coverage, medicare, medicare billing, medicare coverage
The healthcare industry is changing rapidly, creating a host of challenges for healthcare providers. Cutbacks in reimbursements, bad debt and regulatory reforms all affect a provider’s revenue. Moreover, the failure to recognize claim submission mistakes heightens the risk of inadequate reimbursement and even nonpayment. While concentrating on ever-pressing needs, it’s difficult for providers to spot […]
healthcare revenue cycle, Medical Billing, Outsource Billing, Outsource Medical billing, outsourced billing, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, revenue loss, revenue optimization
The Reasons Why a Medical Billing Assessment is Needed Medical Billing Assessments Running a healthcare practice means keeping a tight ship for the sake of your patients and your reputation, as well as your financial well-being. But, let’s face it, practices are only as successful as their medical billing performance. If you have a prosperous […]
Healthcare Billing, Medical Billing, Medical Billing Assessment, Medical Billing Company, medical billing cycle, Medical Billing Profit, Medical Billing Service, medical billing strategy, outsourced medical billing
Understanding Medical Billing Myths Dr. John Smith owns a small practice in Pittsburgh’s South Hills. He’s in the midst of a conversation with one of his nurses. Nurse: “Doctor, do you think we should be posting signs concerning the payment of co-pays once the patient is finished with their appointment?” Doctor: “I agree to a […]
Healthcare Billing, healthcare providers, Medical Billing, Medical Billing Myths, Medical Billing Service, Outsource Billing, Outsource Medical billing, outsourced billing, Pittsburgh Medical BillingMedicare, Medicaid Fraud Examples and Steps to Ensure You Don’t Commit It A medical doctor invoiced his patient’s Medicare insurance for both the services he actually delivered and for services that were not delivered. He fabricated his patient’s medical records to indicate office visits and treatments that never took place. A gerontologist obtained the outcomes […]
billing fraud, false claims act, fraud, medicaid, medicaid billing, medicaid fraud, Medicaid Fraud Examples, medical billing fraud, medicare, medicare billing, medicare fraud, Medicare Fraud Examples, Upcoding
Health Insurers and Prior Authorization Like sands through the hourglass, so are the days of prior authorization “This procedure will require prior authorization.” Words that no patient or healthcare provider wants to hear when they are ready to proceed with a doctor-approved procedure for a medical matter. However, it’s one of the utilization management tools […]
health insurance, healthcare, healthcare providers, Medical Billing, medical credentialing, medical practice, prior authorization, utilization management
Billing & Payment Processing for Medical Marijuana Cannabis A Proven Commodity Marijuana Cannabis is projected to be one of the fastest-growing industries over the next decade. Worldwide cannabis sales more than tripled, from $3.4 billion to $10.9 billion between 2014 and 2018, and Wall Street has forecast that sales will grow $30 billion by 2025. […]
Cannabis Billing, Cannabis-Friendly Payment Processors, Cannabiz, Marijuana Billing, Marijuana Payment Processing, Mary Jane Billing, Medical Billing, Medical Cannabis, Medical Cannabis Billing, Medical Marijuana, Medical Marijuana Billing, Outsource Medical billingMedical Credentialing is Crucial for Healthcare Providers; Here’s Why Truth is, many patients know little more about their physician’s qualifications than what they see neatly hanging from their office wall. While they’re able to access in-depth background information about their auto mechanic, it’s when they are at their most vulnerable, entrusting their family’s health to […]
Credentialing, healthcare credentialing, in-network, insurance companies, medical credentialing, medical provider credentialing, payor contracting, payor enrollment
Medical Billing Techniques that Can Be Installed to Help Your Medical Practice Health care providers should periodically review their financials and revenue cycle, so that they can take corrective measures at the earliest if required. A great deal of medical offices / health care providers find that medical billing is one area which could be […]
AI, Automation, EHR, medicaid, Medical Billing, medicare, MIPS, Outsource Medical billing, Pittsburgh Medical Billing
MACRA is Coming in 2019 How you and your practice get paid is soon going to change. The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, is remodeling the way providers are reimbursed for Medicare services. While this may not affect everyone who bills for Medicare services, it will greatly impact smaller offices […]
Advanced Alternative Payment Model, APM, cms.gov, Cranberry Medical Billing, EHR, Electronic Health Record, MACRA, physician quality reporting system, Pittsburgh Billing, Pittsburgh Medical Billing, PQRS, Value Based System, VBM
New Medicare Cards are set to arrive in 2018 Due to the rising issues of identity theft in the country, the Social Security Administration fears that the current Medicare cards labeled with beneficiaries social security numbers are a high risk. A bill signed in 2015, by President Obama gives the Department of Health and Human […]
2018 Medicare, 2018 Medicare Cards, Cranberry Medical Billing, MBI, Medical Billing, medicare, medicare beneficiary indentifier, medicare cards, new MBI, new medicare cards, Pittsburgh Medical Billing, social security administration, social security number removal initiative, SSNRI
Medical Provider Resources Information for medical providers, including links to NPI, CAQH and ICD-10 resources. Medicare: https://www.novitas-solutions.com NPI Registry portal: https://npiregistry.cms.hhs.gov CAQH provider portal: https://www.caqh.org Free ICD-10 lookup tool: https://www.icd10data.com Navinet Provider portal: https://navinet.navimedix.com 2017-2018 CDC Flu Vaccine Information: https://www.cdc.gov/flu/about/season/flu-season.htm Follow my blog with Bloglovin
CAQH, Coalition for Affordable Quality Healthcare, Cranberry Medical Billing, Cranberry Medical Credentialing, ICD-10, ICD-10 lookup, Medical Billing, medical coding, medical credentialing, medical provider resources, NPI, Pittsburgh Medical Billing, Pittsburgh Medical Coding, Pittsburgh Medical Credentialing, provider resources