What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

-
Image
Choosing a dermatology billing partner based only on a promised clean claim rate can be misleading. A billing company may tell you that it maintains a 95%, 97%, or even 99% clean claim rate. But before accepting that number, you need to know how the rate is measured, what claims are included, and whether those clean claims are actually being paid correctly . For dermatology practices, this matters because a claim can pass an initial billing check and still face problems related to medical necessity, modifiers, procedure coding, payer policies, or underpayment. A clean claim rate should therefore be viewed as one part of the revenue cycle, not the entire performance picture. What Clean Claim Rate Should a Dermatology Billing Partner Guarantee? A reasonable contract target is 97% or higher , provided the billing partner clearly defines the metric and measures it consistently at the payer level. The percentage itself, however, is only part of the agreement. A dermatology practice should a...
Post a Comment

Correct Use of Modifier 50 in ASC Billing

-

 

correctuseofmodifier50inascbilling.jpg

Modifiers are two-digit symbols added to CPT procedure codes to signify the procedure has been altered in some way. Modifiers are accepted by Medicare and most other payers, however, using modifiers correctly can be confusing, since not all payers want modifiers used the same way. Medicare defines the ASC facility’s Global Period to be 24 hours from the time the first procedure begins – it is NOT 10 or 90 days like the physician’s Global Period might be. However, some payers other than Medicare might consider the Global Period to be 48 – 72 hours for ASC facilities. Some Modifiers are for use by physician practices only, some for use on facility claims only, and some are for use by both provider types. In this Blog, we have discussed the correct use of modifier 50 in ASC billing.

Not using Modifiers according to each payer’s specifications can cause unnecessary denials or cause claims to not pay properly. Certain Modifiers are for use because the patient had to return to the OR for another procedure the same day or close to the time another procedure was performed in your facility – which is referred to as the “Global Period” or “Postoperative Period.”

Modifier 50 in ASC Billing: Bilateral Procedures

For Bilateral procedures, use the -50 or -RT/-LT modifiers when an identical procedure is performed on both the Right and Left sides of the body. The policies payors have for the use of modifiers for reporting bilateral procedures can vary. Check with each payor for their preferred method of billing bilateral procedures.

Do not mix methods or modifier types. Never use the -RT/-LT Modifiers on the same code listed on the claim as one line item. Billing with one line item can only be done using the -50 Modifier (which is not accepted by Medicare). Do not mix the -50 Modifier with –RT or –LT Modifiers. Do not use Bilateral Modifiers on those CPT codes with verbiage describing procedures as “Bilateral” or “Unilateral or Bilateral”.

To know more about the Correct Usage of Modifier 50 in ASC Billing and Modifiers LT and RT for Bilateral Procedures, click here: https://bit.ly/40pqtKy Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

Comments

Post a Comment

Popular posts from this blog

Is Your Neurology Billing Outsourcing Helping or Hurting You at Year-End?

-
Image
  As year-end approaches, neurology practices face a crucial decision: Is your billing outsourcing truly improving your financial performance, or silently affecting your revenue? Neurology billing is complex due to time-based coding, modifier usage, high documentation requirements, frequent audits, and prior authorization challenges. If your billing partner lacks neurology-specific expertise, it may lead to claim denials, revenue loss, and compliance risks. Signs Your Neurology Billing Outsourcing Is Helping If your billing partner is performing well, you will see: • Reduced denial rates for neurology codes (EEG, EMG, Botox, Nerve Conduction Studies) • Faster reimbursements and fewer delays from payers • Active recovery of old AR beyond 60, 90, or 120+ days • Accurate CPT, ICD-10, and modifier usage for neurology procedures • Clear billing reports, denial analysis, and revenue insights • Compliance with Medicare, commercial payers, and documentation standards Warning ...
Read more

How Hidden OB-GYN Billing Errors Are Quietly Costing You Millions Each Year

-
Image
  The Silent Revenue Leak in OB-GYN Practices Most OB-GYN practices don’t realize they’re bleeding money. Not in dramatic, headline-grabbing ways, but quietly, steadily, month after month. The phones are ringing, appointment slots are full, deliveries are happening, and yet the numbers never seem to match the effort. Sound familiar? This is often the first sign of hidden OB-GYN billing errors working behind the scenes. These errors don’t announce themselves. They don’t crash your systems or send angry alerts. Instead, they slip through claims, hide in coding nuances, and quietly shave thousands—or millions—off your annual revenue. OB-GYN billing is uniquely complex compared to other specialties. Between global maternity packages, split billing scenarios, high-risk pregnancy coding, and ever-changing payer rules, the margin for error is enormous. A single missed modifier or incorrectly bundled service might seem insignificant on its own. But when repeated across hundreds or thousand...
Read more

Why High-Volume Primary Care Clinics Still Struggle with Cash Flow in 2026

-
Image
Patient volume alone does not guarantee financial success. Many high-volume primary care clinics are seeing more patients than ever in 2026, yet they continue to experience declining cash flow, increasing accounts receivable (AR), and inconsistent monthly collections. Despite busy schedules and full appointment books, reimbursement delays, payer denials, coding errors, and administrative inefficiencies often prevent practices from converting clinical activity into predictable revenue. Today's primary care environment is more complex than ever. Evaluation and Management (E/M) coding updates, Medicare Advantage policies, commercial payer requirements, prior authorization rules, and preventive care reimbursement all contribute to a challenging revenue cycle. This is why many providers are asking: Why do high-volume primary care clinics still struggle with cash flow in 2026? The answer often lies within the billing process. Practices that invest in specialized Primary Care Billing Ser...
Read more