New codes and guidelines become effective Oct. 1, 2023. The Centers for Medicare & Medicaid Services (CMS) published the ICD-10-PCS codes and guidelines for the 2023 fiscal year on May…
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any…
Just when you think your practice is running without a hitch, it happens. You receive notice of an audit from one or more of your payors, demanding detailed records on…
How to stay compliant in behavioral health screenings. Behavioral health screenings aim to detect mental health symptoms in many seemingly healthy people. This can be done in various ways, including…
The Department of Health and Human Services is announcing a funding opportunity of nearly $15 million for a three-year federal grant to establish a Substance Abuse and Mental Health Services…
Medical billing and coding is one of the hottest medical professions in great demand with a great deal of job opportunities and rooms for promotion. Promotion will come with increment…
Some flareups may lead to readmissions within 30 days. We can all agree that we want to fully treat our patients’ acute problems that require inpatient hospitalization, allowing them a…
Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient…
You might know that medical billing is a challenging process. That’s the reason why many people make several mistakes in this case. If you have the same problem, you can…
In a recent study posted to the medRxiv* preprint server, researchers evaluated the use of U09.9, an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code described as 'Post…
CMS has released its Hospital Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year 2023, which includes a payment rate boost for general acute care hospitals and new measures…
Hospitalizations appear to be more complex, requiring greater attention from the multidisciplinary team. As we know, with the growth of outpatient surgical centers, advances in medical technology, and the shift…
The average cost of debunking a denial is $25 per claim, not to mention the continuous challenges associated with attaining timely payment. Reviewing denial management strategies on a regular basis…
Providers are bracing for the end of government funds to administer COVID-19 vaccines. Starting Tuesday, April 5, the Department of Health and Human Services will no longer adjudicate claims submitted…
The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) initiative is a new model for ACOs operating under Medicare. It will be tested under the Centers for…
The American Medical Association (AMA) recently announced three new CPT codes for administration of Pfizer’s COVID-19 vaccine in children 6 months to under 5 years old, JustCoding reported. The new product and…