Billing & Credentialing Cranberry Twp. (Pittsburgh)
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Modifiers

Tough Questions Providers May Ask Billers

December 1, 2024 / admin / Articles, Billing, Claim Denial Rate, Claim Denials, Compliance, EHR, EMR, Interoperability, Medical Billers, Medical Billing, Medical Billing Questions, Modifiers, Reimbursement, Reimbursement Models, Reimbursement Optimization
Latina Female Medical Provider Owner

The relationship between medical providers and their billing teams has become increasingly crucial to practice success. As reimbursement models grow more complicated and regulatory requirements more stringent, providers often find themselves grappling with challenging questions about their revenue cycle management. We’ll address the most demanding and complex questions that medical providers frequently ask their billing […]

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billing, Claim Denial Rate, Claim Denials, compliance, EHR, EMR, Interoperability, Medical Billers, Medical Billing, medical billing questions, Modifiers, reimbursement, Reimbursement Models, Reimbursement Optimization

Common Skilled Nursing Facility (SNF) Modifiers

August 21, 2024 / admin / Articles, Modifier 25, Modifier 59, Modifier 76, Modifier 77, Modifier Code, Modifier Codes, Modifier EY, Modifier FX, Modifier GG, Modifier GO, Modifier GP, Modifier KX, Modifier LT, Modifier RT, Modifiers, Skilled Nursing, Skilled Nursing Billing, Skilled Nursing Facility, Skilled Nursing Modifiers, SNF Modifiers

Skilled Nursing Facilities (SNFs) play a critical role in providing comprehensive post-acute care. Accurate medical billing and coding for SNF services is essential not only for appropriate reimbursement but also for maintaining compliance with regulatory requirements. One key component of this process is the proper use of modifiers. These two-character codes provide additional details about […]

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Modifier 25, Modifier 59, Modifier 76, Modifier 77, Modifier Code, Modifier Codes, Modifier EY, Modifier FX, Modifier GG, Modifier GO, Modifier GP, Modifier KX, Modifier LT, Modifier RT, Modifiers, skilled nursing, skilled nursing billing, skilled nursing facility, Skilled Nursing Modifiers, SNF Modifiers

Common Genetic Testing Modifiers

August 20, 2024 / admin / Articles, Carrier Testing, Diagnostic Testing, Modifier 33, Modifier 59, Modifier 76, Modifier 91, Modifier KX, Modifier QM, Modifier QP, Modifier ZA, Modifier ZB, Modifiers, Newborn Screening, Pharmacogenetics, Pharmacogenomic Testing, Predictive and Presymptomatic Testing, Tumor Profiling
Genetic Testing Modifier

As our understanding of genetics and its role in healthcare continues to expand, so does the complexity of billing for these services. One of the key elements in ensuring accurate billing and appropriate reimbursement for genetic testing is the proper use of modifiers. These two-character codes provide additional information about the services rendered, helping to […]

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Carrier Testing, Diagnostic Testing, Modifier 33, Modifier 59, Modifier 76, Modifier 91, Modifier KX, Modifier QM, Modifier QP, Modifier ZA, Modifier ZB, Modifiers, Newborn Screening, Pharmacogenetics, Pharmacogenomic Testing, Predictive and Presymptomatic Testing, Prenatal Testing, Tumor Profiling

Medicare Modifier XU and How To Use It

August 15, 2024 / admin / Articles, CMS, Coding, Coding and Billing, Coding and Documentation, Medicare, Medicare Modifier XU, Medicare Modifiers, Modifier Code, Modifier Codes, Modifier XU, Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Modifier XU

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, […]

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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

Medicare Modifier XS and How To Use It

August 13, 2024 / admin / Articles, Coding, Coding and Billing, Medicare, Medicare Modifier XS, Medicare Modifiers, Modifier XE, Modifier XP, Modifier XS, Modifier XU, Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Modifier XS

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 […]

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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

Navigating the Complexities of Behavioral Health Billing

May 31, 2024 / admin / Articles, Behavioral Health, Behavioral Health Billing, Billing, Billing Best Practice, Billing Challenges, Billing Codes, Coding, Coding and Billing, Modifier Codes, Modifiers, Pre-Authorization, Preauthorization
Behavioral Health Billing

Let’s be real, billing and claims processing is probably not what got you into the behavioral health field in the first place. You were driven by a passion to help people overcome mental health challenges, develop positive coping strategies, and improve their overall well-being. But as much as we might wish it were different, managing […]

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Behavioral Health, Behavioral Health Billing, billing, Billing Best Practice, Billing Challenges, Billing Codes, Coding, coding and billing, Modifier Codes, Modifiers, Pre-Authorization, Preauthorization

New Medicare Modifiers XE, XP, XS, XU: Examples of When to Bill Each One

February 13, 2024 / admin / Articles, CMS, Coding, Healthcare, Healthcare Billing, Medical, Medical Billing, Medicare Modifiers, Modifier Code, Modifier XE, Modifier XP, Modifier XS, Modifier XU, Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Medical Biller Modifiers

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, […]

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CMS, HCPCS, Medicare Modifiers, Modifier XE, Modifier XP, Modifier XS, Modifier Xu, XE, XE: Separate encounter, XP, XP: Separate practitioner, XS, XS: Separate structure, XU, XU: Unusual non-overlapping service

What are and When to Use Modifier Codes

February 10, 2024 / admin / Anatomic Modifiers, Articles, Bilateral Surgery Modifiers, CMS, Coding, CPT, CPT Codes, CPT Definitions, Global Surgery Modifiers, HCPCS Codes, Medical, Medical Billing, Medical Coding, Missing Modifiers, Modifier Codes, Modifiers, Procedure Modifiers
Medical Billing White Guy

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 […]

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Anatomic Modifiers, Bilateral Surgery Modifiers, billing, Coding, coding and billing, CPT, CPT definitions, CPT-10, Global Surgery Modifiers, HCPCS, healthcare, Healthcare Billing, Medical, Medical Billing, medical coding, medical necessity, NCCI, NCCI Edits, payer policies, Procedure Modifiers, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization

What’s the Difference Between Comprehensive, Component, and Modifier Codes?

February 9, 2024 / admin / Articles, Billing, Bundled Payments, Bundling, Component Codes, Comprehensive Codes, CPT Manual, Healthcare, Healthcare Billing, Medical, Medical Billing, Modifier Code, Modifiers, Unbundling
Medical CPT Codes

Medical billing and coding is an intricate process that requires the use of 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. Understanding the differences between these code types is crucial for accurate medical billing and reimbursement. Comprehensive Codes […]

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-AS, -AT, -CG, -LT, -RT, adjunct services, ancillary services, billing, bundling, care settings, Component Codes, comprehensive codes, CPT Manual, healthcare, Healthcare Billing, laterality, Medical, Medical Billing, Modifier Codes, Modifiers, patient conditions, rcm, Revenue Cycle, Revenue Cycle Management, revenue cycle optimization, Unbundling, unusual circumstances

The Essential Guide to Avoiding Improper Bundling in Medical Billing

February 6, 2024 / admin / Articles, Bundling, Component Codes, Improper Bundling, Medical Billing, Medically Unlikely Edits, Modifier Code, Modifier Codes, Modifiers, MUEs, National Correct Coding Initiative, NCCI, NCCI Edits, Proper Bundling, Unbundling
White Female Medical Billing Outsourced

Improper bundling in medical billing can lead to denied claims, payment delays, audits, fines, and even fraud allegations. As a medical billing professional, it’s crucial to understand how to bundle procedures correctly to ensure proper reimbursement while adhering to CMS guidelines. In this guide, we’ll cover everything you need to know about avoiding improper bundling […]

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Claim Denials, Component Codes, Comprehensive Code, CPT, CPT codes, denied claims, denied medical claims, HCPCS, Medically Unlikely Edits, Modifier Codes, MUEs, National Correct Coding Initiative, NCCI, NCCI Edits, Unbundling

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Practices Served

  • Behavioral Health
  • Genetic Testing
  • Pharmacogenetic (PGx) Testing
  • Toxicology
  • COVID-19 Testing
  • Allergy Testing
  • Skilled Nursing Facilities
  • Urgent Care
  • Oncology
  • Pathology
  • OBGYN
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Speech Therapy
  • Substance Abuse
  • DME
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy

Practices Served

  • Behavioral Health
  • Genetic Testing
  • Pharmacogenetic (PGx) Testing
  • Toxicology
  • COVID-19 Testing
  • Allergy Testing
  • Skilled Nursing Facilities
  • Urgent Care
  • Oncology
  • Pathology
  • OBGYN
  • Biologics and Specialty Drugs
  • Telestroke and Teleneurology
  • Remote Patient Monitoring
  • Remote Therapeutic Monitoring
  • Home Infusion Therapy
  • Speech Therapy
  • Substance Abuse
  • DME
  • Sleep Study Labs
  • Physical Therapy (PT)
  • Occupational Therapy

Recent Posts

  • Laboratory Billing

    Which CPT Codes are Used in Laboratory Billing?

  • Medical Credentialing Staff at a Hospital

    25 Stats Medical Credentialers Must Know

  • Older Female Doctor in need of Credentialing

    Credentialing Problems? We Can Fix Them!

  • Medical Credentialing State-by-State

    Multi-State Licensing in Provider Credentialing

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