How to Credential Your Practice with Vision Plan?
You just graduated from a school of optometry and decided your practice location. If you plan on examining patients who wish to use their vision and medical insurance, you must be an ‘in-network...
View ArticleCoding for Open Fracture Debridement
Basics of Open Fracture Debridement Debridement is used to remove foreign material or damaged, dead, or contaminated tissue from a surgical field, wound, or injury. Debridement is used to promote...
View ArticleOutpatient E/M Revisions for 2021
The American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) has announced guideline and code descriptor changes for outpatient E/M services to be effective from Jan....
View ArticleWhat is the Medicare Crossover Claim?
A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and/or...
View ArticleStreamlining and Automating Prior Authorization
CMS’s Proposed Rule on Automating Prior Authorization On 10th December 2020, The Centers for Medicare & Medicaid Services (CMS) proposed a new regulation aimed at improving the sharing of...
View ArticleClinical Documentation: Great Way to Improve Coding
Medical documentation and coding are bricks and mortar of the medical billing process. In the past 25-30 years, we seen the increased importance of documentation and coding. Compliant clinical...
View ArticleDefining ‘Reasonable and Necessary’ Coverage for Medicare
Medicare won’t provide coverage for items and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury. National coverage determinations (NCDs) are made...
View ArticleExpansion of Medicare Reimbursement for Home Dialysis
The Centers for Medicare & Medicaid Services (CMS) on 2nd October 2020, finalized policies that allow certain new and innovative equipment and supplies used for dialysis treatment of patients with...
View ArticleValue-Based Care Vs Fee-for-Service
As healthcare regulations change, so do healthcare provider reimbursement models. Understanding different forms of reimbursement and their advantages and disadvantages can help you better figure out...
View ArticleNewly Added CPT Code for Janssen COVID-19 Vaccine
On 19th Jan 2020, the American Medical Association (AMA) added new CPT codes (91302 and 0031A) for Janssen COVID-19 Vaccine, a division of Johnson & Johnson. Janssen is a single-dose COVID-19...
View ArticleNewly Added Code for Transanal Hemorrhoidal Dearterialization (THD)
Replacing Code 0249T CPT Category III code 0249T, ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance, has been deleted and converted to CPT Category I code 46948,...
View ArticleBilling for Loss of Protective Sensation (LOPS)
Loss of Protective Sensation (LOPS) Basics Diabetic sensory neuropathy, or peripheral neuropathy, is the most common factor leading to amputation in people with diabetes. In diabetes, sensory...
View ArticleThe time has come to get credentialed first!
As medical credentialing enables the patients to confidently trust their chosen healthcare providers, it has become very crucial. A medical practitioner cannot work at a hospital legally or partner...
View ArticleTo PECOS or Not to PECOS!
PECOS is the short form for Provider, Enrollment, Chain, and Ownership System. It is a database where doctors register with the Centers for Medicare and Medicare Services (CMS). It is a national...
View ArticleHow Does Having CAQH ID Help in Credentialing?
Medical Credentialing is the process of requesting to participate in a health insurance provider network – or to be contracted with the insurer. Healthcare providers have to apply to and must be...
View ArticleEfficient RCM Process is the Key to Provider Success in 2021
To overcome the financial impact of pandemic, providers need to measure and focus on an efficient RCM process to get success in 2021. COVID-19 pandemic has a severe impact on the healthcare industry,...
View ArticleSave your time by knowing key payers to get credentialed with!
Provider insurance credentialing is a complex and time-consuming process. Once you have decided to start the credentialing process, your first task would be knowing key payers to get credentialed with....
View ArticleMedicare Coverage for Wound Care
Medicare covers wound care for all beneficiaries, irrespective that it carried out inpatient or outpatient setting. Wound care can be expensive for patients. Few peoples may suffer from post-surgical...
View ArticleImplementation of Time-Driven Costing in Healthcare
The high level of spending on healthcare in the United States has been under increasing scrutiny for a long time. The realization that growth in health care spending in the US has outpaced growth in...
View ArticleThings to know about Cardiology Billing and Coding
Cardiology billing and coding are complex for several reasons. This specialty experiences regular amendments of key procedure rules, complex contractual adjustments, and codes, and that is the reason...
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