Medical Billers and Coders

  The basics of ASC Coding And Billing aren’t hard to master, but they do differ from physician and facility requirements. The following overview will help you know what’s most important in the ASC setting. ASCs use a combination of hospital and physician billing. Although ASCs use CPT and HCPCS Level II codes to bill most of their services (as do physicians), some payers will allow an ASC to bill ICD-10-CM procedure codes (like a hospital). Some payers even base implant reimbursement on revenue code classification. One of the most fundamental differences between billing for professional services and billing for ambulatory surgery center services is the concept of the global surgical package. The global package applies to the professional component of a surgical service that is performed when using a surgical CPT code. On the professional side, this typically encompasses a 90-day follow-up. In the  ASC billing  methodology, no such surgical package exists. Ther...

2023 Medicare Physician Fee Schedule Proposed Rule Recently, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 revisions to payment policies under the Medicare Physician Fee Schedule (MPFS) and other changes to the Medicare part B payment policies (CMS-1770-P) proposed rule. In this article, we shared the impact of the 2023 MPFS proposed rule on  neurology billing , the key points are as follows: Impact of 2023 MPFS Proposed Rule on Neurology Billing CMS shows the impact of the provisions of the rule to be a zero percent chance for neurosurgery. However, CMS proposes a CY 2023 conversion factor (CF) of 33.0775, which is a 4.42 percent (rounded to 4.5%) reduction relative to the CY 2022 CF of 34.6062, which comes in addition to the pending 4% pay-as-you-go cut that congress postponed last year and the resumption of the 2% annual Medicare payment sequester. CMS received a request to designate CPT code 23091 (Allograft, structural, for spine surgery only) a...

  On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities (SNF) for the year 2023. This SNF PPS (Skilled Nursing Facility Prospective Payment System) includes proposals for the SNF Quality Reporting Program (QRP) and the SNF Value-Based Program (VBP) for FY 2023 and future years. This proposed rule CMS is publishing this proposed rule consistent with the legal requirements to update Medicare payment policies for nursing homes on an annual basis.  What is the SNF QRP? The SNF QRP creates SNF quality reporting requirements, as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).  Every year, by October 1, CMS publishes the quality measures SNFs must report. The IMPACT Act requires the reporting of standardized patient assessment data with regard to quality measures and standardized patient assessment data elemen...

CY 2023 Medicare Physician Fee Schedule (MPFS) The Centers for Medicare and Medicaid Services (CMS) on Nov. 1, 2022, released the final 2023 Medicare Physician Fee Schedule (MPFS), addressing Medicare payment and quality provisions in the coming year. The U.S. Department of Health and Human Services (HHS) through its Centers for Medicare & Medicaid Services (CMS) is expanding access to behavioral health care. The Calendar Year 2023 Physician Fee Schedule (PFS) final rule announced today also promotes innovation and coordinated care in the Medicare program through Accountable Care Organizations (ACOs). This rule directly supports the Administration’s commitment to strengthening behavioral health, which the President outlined in his first State of the Union Address, and the comprehensive strategy to tackle the nation’s mental health crisis. In this article, we shared key behavioral health billing updates from CY 2023 MPFS which would act as a baseline for your behavioral health billi...

Medical billing and coding for general surgery are not as simple as you think. Besides being educated in procedures ranging from hernia repair to bladder surgery, the billing and coding staff need to be knowledgeable in the proper use of the global surgical package, modifiers for surgeon roles and same-day procedures, and citations for unlisted procedures. Mistakes can lead to lower reimbursements and cause compliance issues. The General Surgery Billing Pitfalls are issues that many hospitals and medical facilities experience and can be avoided with practice and patience. General Surgery Billing Pitfalls A medical billing, coding, and  revenue cycle management  association can assist your billing staff by performing periodic audit risk assessments, helping minimize compliance issues, and helping your practice bill more efficiently and effectively. Depending on your facility’s general surgery practice needs, you may also benefit from outsourcing all or part of your billing, cod...

Behavioral health billing is quite challenging as various factors affect the billing process. The length of the session, the approach to therapy, and the willingness of the patient to partake make it far more difficult to standardize treatment and billing. Moreover, the manner in which insurance carriers look at behavioral health is noticeably unlike the way they look at more traditional medical practices. For example, insurance carriers determine how long treatments are allowed to take and how many sessions can take place each day, making it challenging for behavioral health practitioners to balance effective billing with adequate patient treatment. In such challenging billing conditions, behavioral health practitioners can benefit from assistance from the medical billing company.   Medical Billers and Coders (MBC)   is a best-in-class   behavioral health billing   company providing complete behavioral health services. With our help, you can focus only on patie...

Medical Billing itself is a complicated process. However, medical billing for Behavioral health is a whole new level of complexity. We make the Behavioral Health Billing Process smoother and more efficient to get paid faster. Behavioral Health billing comes with its own set of unique and complex challenges. Between the types of services offered, unbundling concerns, pre-authorization, and the number of staff and their time availability, behavioral health facilities are often at a disadvantage compared to other health professionals. By ensuring that the process for Behavioral Health Billing is running error-free you can spend more time and energy focusing on what truly matters – you can focus on your patients. Why is Behavioral Health Billing So Difficult and Complex? Medical billing for behavioral health services is more complex than other areas of healthcare of the types of services, scope, time, and restraints placed on behavioral treatments. For an instance, if someone visits a beha...