"Upcoding" means reporting a higher-level service or procedure or a more complex diagnosis, than is supported by medical necessity, medical facts, or the provider's documentation. For example, reporting a diagnosis…
Z23. That’s the ICD-10 billing code for an immunization encounter. It’s also the only code that stumped the team at Arlington, Virginia-based Privia Health, a national medical group. “It’s a…
After months studying a growing balance billing problem, Pennsylvania Insurance Commissioner Teresa D. Miller suggests patients should be removed from the dispute. In a public comment period that ends Feb.…
2016 may be a big year for revenue cycle management. Healthcare organizations see steady claims denial post-ICD-10 implementation and remain focused on value-based care models. Healthcare organizations are focused on strengthening revenue…
The Centers for Medicare & Medicaid Services has launched an online resource to support states' efforts to update outdated IT systems, Andy Slavitt, CMS' acting administrator, announced on Monday. Through…
Reimbursement for procedures is an ASC's bread and butter. Here are eight things to know about surgery center reimbursement. 1. Surgery center reimbursement comes from several sources, according to the…
Say goodbye to the server, the future of health technology lies in the cloud. Thanks to advances in security and reliability, affordable web-based technology is more popular with physicians than…
In the wake of the Oct. 1 transition to ICD-10, very few issues have surfaced. However, providers and billers have experienced difficulty with coding for medical necessity, receiving denials due…
Poor documentation, decrease in productivity among main ICD-10 challenges thus far. Leading up to the healthcare industry’s transition to the ICD-10 coding set on Oct. 1, 2015, there seemed to…
“They’d only take ‘sequela’ or they’d only take ‘subsequent,’ and it was not necessarily understood what those seven characters meant." Lack of training for inpatient procedural coding may pose a…
The ICD-10 transition is negatively impacting inpatient and outpatient coder productivity at hospitals of all sizes and types, according to survey results from healthcare outsourcing vendor HIMagine Solutions Inc. The…
The U.S. health care system began using the International Classification of Diseases 10th edition on Oct. 1. ICD-10 replaces the decades-old 9th edition, and it represents the largest change in…
For many practices, the day of Oct. 1, 2015 was the nerve-wracking great switch over from ICD-9 to ICD-10. Small practices were pegged as ill-prepared for the storm that was…
On Thursday, CMS announced that about 10% of claims submitted since the Oct. 1 transition to ICD-10 have been rejected, but only a small percentage of those were denied because…
Payer software vendor and claims clearinghouse TriZetto Provider Solutions has seen a small uptick in insurers rejecting providers’ ICD-10 claims as the new code set enters its third week. Overall,…
New codes are coming for the Current Procedural Terminology (CPT) code set to bring more specificity to coding for an expanding range of telehealth services. The American Medical Association, which…