Stop Losing $$$ on Well Woman Exam Claims — CPT Coding Best Practices for Gynecology Practices

-
Image
Well-woman exams sound simple. They’re not. Gynecology practices lose thousands every year because payers deny, downcode, or bundle these visits due to coding errors, missing documentation, or confusion between preventive vs. problem-oriented care . If your practice is seeing unpaid or underpaid Well Woman claims, here’s the reality: It’s not the payer. It’s not the patient. It’s your coding workflows—and they’re costing you real money. Below is the no-nonsense breakdown of how to stop revenue leakage immediately. Why Gynecology Practices Keep Losing Money on Well-Woman Exams Most losses happen because of wrong CPT/ICD pairing , incorrect use of preventive codes, and failure to separate problem visits from preventive services. Top revenue killers: 1. Using the wrong preventive CPT code Common mistakes include: Billing 99381–99397  is incorrectly based on age Missing counseling or preventive components that justify higher-level codes Treating a preventive exam...
Post a Comment

Physician and Hospital Billing-What’s the Difference?

-

physicianandhospitalbillingwhatsthedifference.jpg

Physician billing, which is also termed Ambulatory Surgical Center (ASC) billing or professional billing is the billing of claims for services, which were offered or performed by healthcare professionals or a physician that also includes inpatient and outpatient services. In this blog, we will take a quick look at both physician and hospital billing.

Majorly, these claims are billed electronically as the 837-P form. Institutional billing deals with claims for procedures or work executed by institutions like nursing facilities, inpatient and outpatient centers, and hospitals. Moreover, these claims need the 837-I electronic version or the UB-04 paper form. Institutional or hospital billing is basically more complicated and needs separate billers as well as coders.

As far as physician billing is concerned, the role of billers and coders is merged many times. Nevertheless, when we emphasize medical billing and coding, one should specifically understand that physician billing services and hospital billing agencies are of a similar craft, it varies with coding undertakings and their names.

Difference Between Physician and Hospital Billing:

Physician Billing

Professional billing or Physician billing is responsible for billing cases for procedures performed by physicians, suppliers, and other non-institutional suppliers for outpatient and inpatient administrations. On a CMS-1500 form, professional charges were charged. The form is white in color and the letters are printed in red ink. Moreover, the CMS-1500 form is used by suppliers and doctors for case charging.

There are still some cases that are charged on paper while Medicaid, Medicare, and most insurance companies accept electronic claims, as the necessary charging strategy. The 837-P is an electronic version of CMS-1500. The P stands for professional configuration. An expert physician billing services sometimes have numerous job responsibilities compared to institutional or hospital billers.

To know more about the Difference Between Physician and Hospital Billing click here: http://bit.ly/3ZfkjvL Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

Comments

Post a Comment

Popular posts from this blog

How to Reduce Days in A/R with Smart Denial Management Strategies

-
Image
 Timely reimbursement is the lifeblood of a financially healthy medical practice. Yet, increasing Days in Accounts Receivable (A/R) continues to be one of the most pressing revenue cycle issues for healthcare providers. One of the major culprits behind this issue? Denials. In this blog, we explore how strategic denial management not only reduces days in A/R but also improves cash flow and strengthens your bottom line. Understanding Days in A/R Days in A/R refers to the average number of days it takes for a practice to collect payments due after services have been provided. Industry benchmarks typically suggest keeping A/R days under 35. Anything higher signals inefficiencies - and likely unresolved denials. How Claim Denials Affect A/R Denied claims delay payments and increase administrative burden. Without an effective process to identify, appeal, and correct them, your A/R days will climb - and revenue will suffer. Top causes of denials include: Missing or incorrect ...
Read more

How Outsourced Medical Billing Can Improve Your Practice’s Profitability

-
Image
Managing a medical practice comes with its fair share of challenges—from patient care to staffing and compliance. But one of the most overlooked factors impacting a practice’s financial health is inefficient billing . That’s where outsourced medical billing comes in—not just as a cost-cutting solution, but as a profitability booster . Here’s how outsourcing your medical billing can significantly improve your bottom line. 1. Reduced Administrative Costs Running an in-house billing department requires trained staff, billing software, continual updates, and compliance oversight. These overhead costs can add up quickly. Outsourcing eliminates the need for these expenses, allowing you to pay only for the services you use —often at a fraction of the cost. 2. Faster Claim Submission and Reimbursement Professional billing companies are equipped with experienced teams and advanced tools that ensure quick and accurate claim submission . This minimizes delays and accelerates cash flow , g...
Read more

Understanding the Differences Between Claim Denials and Rejections in Medical Billing

-
Image
In the world of medical billing, two terms often cause confusion for healthcare providers and billing staff alike: claim rejections and claim denials . While both impact revenue and delay reimbursements, they are not the same —and understanding the difference is key to faster, cleaner claim processing. Let’s break it down. What Is a Claim Rejection? A claim rejection occurs when a claim is never accepted into the payer’s adjudication system . It is blocked due to errors or missing information , such as: Incorrect patient demographics Invalid insurance ID numbers Incomplete CPT or ICD-10 codes Formatting errors (especially in EDI files) These claims must be corrected and resubmitted —but the good news is they haven't been officially processed yet, so no appeal is needed . What Is a Claim Denial? A claim denial happens after the payer reviews and processes the claim , then decides not to pay it . Reasons may include: Lack of medical necessity Services n...
Read more