Category Archives: Medical Billing Services

What is a modifier 53 mean?

What is a modifier 53 mean?

Modifier 53 could almost be stated to as a forgotten modifier; practices forget or just never find out how to appropriately use it. This is often partially because there’s no set definition for ‘extenuating circumstances,’ leaving it susceptible interpretation and diminishing appropriate use. It’s especially unfortunate how disused modifier 53 is, because by not using […]

Medicare Physician Fee Schedule 2021

Medicare Physician Fee Schedule 2021

The CY 2021 Medicare Physician Fee Schedule Proposed Rule with comment period was placed on display at the Federal Register on August 4, 2020. This proposed rule updates payment policies, payment rates, and other provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2021. “During the pandemic, physicians […]

CPT Code 99072

CPT Code 99072

Current Procedural Terminology Code 99072 Reporting: Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease. When reporting […]

Tips for an Effective Claims Denial Management Audit

Tips for an Effective Claims Denial Management Audit

According to the American Medical Association (AMA), 25 to 30 percent of the country’s total health care costs are direct transaction costs and inefficiencies associated with the “claims management revenue cycle”. Increasing proficiency and improving collection should be top priorities for health care providers with mainly focused on improving prior authorizations and eligibility before an […]

Use of MODIFIER GQ – Telehealth Modifier

Use of MODIFIER GQ – Telehealth Modifier

What is the GQ modifier? Per the AMA, Modifier GQ means, “Via an asynchronous telecommunications system.” Asynchronous telemedicine means that medical care was provided via image and video that was not provided in real-time. According to John Verhovshek, when reporting a covered end-stage renal disease-related service telehealth code (e.g., 90951 End-stage renal disease (ESRD) related […]

Out-of-Network COVID-19 Test Cost is higher than the commercial price

Out-of-Network COVID-19 Test Cost is higher than the commercial price

According to a new report provider prices for out-of-network COVID-19 tests are higher than the average cost of in-network tests. America’s Health Insurance Plans (AHIP) is calling on the government to stop price gouging after finding provider prices for out-of-network COVID-19 tests far exceeded the average cost of in-network tests. In a report released late […]

Fundamentals to avoid Claims Denials

Fundamentals to avoid Claims Denials

For any practice, reducing the claims denials can put them on the path to increase in reimbursement. Your staff or outsourced billing company often sees the word “claim denied”, which leads to increased work and less revenue for your practice over a time. American Medical Association study found that many medical practices spend thousands of […]

How to get success in risk-based payment model

How to get success in a risk-based payment model?

Reimbursement insufficiency, data on time, and most important data access are preventing hospitals and health systems from moving to risk-based payment, according to a recent survey from healthcare improvement company Premier. What is a risk-based payment model? According to American Academy of Pediatrics, There are a variety of risk-based or budget-based payment models being developed. […]