In the coding world there is always an emphasis on the importance of documentation. We are all familiar with the saying “If it’s not documented, it wasn’t done”. We must also place equal importance on making sure all the information that is documented is also translated onto the claim. This is important for a …
The importance of accurately reporting ICD10-CM with ultrasounds Read More »
Prior Authorization continues to be a significant barrier for patients and providers. It has caused greater financial waste for providers and increased delays for patients. According to the AHA survey, one 17-hospital system reported spending $11 million annually just to comply with health plan prior authorization requirements. Efforts to streamline and standardize have failed …
In 2021, when the Evaluation and Management guidelines were revised, the area with the most confusion was ultimately the amount and/or complexity of data to be reviewed and/or analyzed. Like with other components, misunderstandings with definitions and descriptions were at the root of the problem. It is extremely important to read the full description and …
In 2004 I took on my second specialty in Healthcare in the world of Opthalmology. I was introduced to the specialized procedures and services performed by professionals in this space. Over the next few years I dug into this specialty learning the Anatomy, Disease Process and importance of eye health. Years of Audits led me …
It’s no secret that the most widely misunderstood and misused modifier in Medical Billing and Coding is Modifier 25. I have worked in the Revenue cycle for 20 years, and even in this day and age with so much education and easy ways to access regulatory guidance, many still misunderstand its use. Modifier 25: …
It’s a fact that in the current healthcare landscape that the amount of Prior Authorization errors or lack thereof are draining the healthcare industry in finance and resources. When a patient needs a service, and a facility is overrun with orders it can be a very complicated task for a clinic or facility to manage with so many …
What is an EOB or Explanation of Benefits? Every insurance payer will give a written explanation of the charges you submitted, what they will pay or not pay, what the patient may or may not owe and any reasons for non payments. How to read an EOB Most patients are not able to understand how …
