Blog

Blog

Importance of provider credentialing

Importance of provider credentialing

What is the credentialing process for healthcare providers? Provider credentialing is the process of establishing that medical providers have proper qualifications to perform their jobs. This requires contacting a range of organizations, including medical schools, licensing boards, and other entities, to verify that the providers have the correct licenses and certificates. What are credentialing services? […]

The health insurance affordability gap

The health insurance affordability gap

Targeted Medicaid growth, boosting state contributions to Affordable Care Act marketplace grants, or a hybrid of these options may help rise payer coverage affordability. Healthcare coverage is far away out of reach for many low-income Americans due to healthcare cost. But 3 innovative solutions for Connecticut might shed light on how to boost payer coverage […]

How to improve medical billing accuracy in CY 2021

How to improve medical billing accuracy in CY 2021?

The medical billing and coding process is a complex. When a patient presents with a significant medical history or complicated case billing can be time-consuming taking days, or months, to finalize. On top of that recent amendments to the U.S. healthcare system have added a variety of new challenges for both providers and patients. Various […]

Medical Examinations and Evaluations with Initiation of Diagnostic and Treatment Program

Medical Examinations and Evaluations with Initiation of Diagnostic and Treatment Program

CPT codes 92002-92014 are for medical examination and evaluation with initiation or continuation of a diagnostic and treatment program. The intermediate services (92002, 92012) describe an evaluation of a new or existing condition complicated with a new diagnostic or management problem with initiation of a diagnostic and treatment program. They include the provision of history, […]

Value-Based Care in Behavioral health

Value-Based Care in Behavioral health

Basics of Value-Based Care The value-based care model is designed to get more attention across the healthcare insurance industry. This is still being moderated to be perfect to deliver quality in care and not a quantity, care that will reward or penalize healthcare providers for patient or client outcomes. The ultimate goal of Value-Based Care […]

Medication Therapy Management Programs

Medication Therapy Management Programs

The Part D Enhanced Medication Therapy Management (MTM) model tests whether providing Part D sponsors with additional payment incentives and regulatory flexibilities promotes enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures. The model is an opportunity for stand-alone basic Part D plans to right-size their investments in MTM […]

When is it appropriate to use modifier 90?

When is it appropriate to use modifier 90?

Reference (Outside) Laboratory When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding the modifier 90 to the usual procedure number. Modifier 90 should be appended to the procedure code representing the laboratory service that is being submitted to an outside laboratory for […]

What is advance beneficiary notice in medical billing

What is advance beneficiary notice in medical billing?

An advance beneficiary notice is a written notice (standard government form CMS-R-131) from Medicare, given to patient before they receive certain equipment or services, notifying patient that: Medicare may not provide reimbursement for that specific procedure or treatment Patient will personally responsible for complete payment if Medicare decline payment An ABN provide an opportunity to […]

Correct Debridement Codes - Wound Care

Correct Debridement Codes – Wound Care

Debridement is a medical procedure for treating a wound within the skin. It involves thoroughly cleaning the wound and removing all hyperkeratotic (thickened skin or callus), infected, and nonviable (necrotic or dead) tissue, foreign debris, and residual material from dressings. Debridement Coding Guidelines Debridement of a wound, performed before the application of a topical or […]