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

Determining Drug Coverage for Original Medicare

-

 

determiningdrugcoveragefororiginalmedicare.jpg

Determining Medicare Drug Coverage

While billing for Skilled Nursing Facilities (SNF) or for hospital billing, billers always make the mistake of considering the wrong Medicare drug coverage. For example, Medicare Part A and Part B generally do not cover outpatient prescription drugs, most of which are covered under Part D. In this article, we shared an excerpt from a CMS document, which will act as a basic tool to assist you in understanding Medicare drug coverage determinations under Part A, Part B and Part D of Medicare, and to clarify coverage for specific Part D products/drugs/categories. 

We also shared billing scenarios, which will help you to determine which part of Medicare covers a drug in a particular situation, assuming all other requirements are met, e.g., a drug must still be medically necessary to be covered. This information is applicable to people in the Original Medicare Plan. People who have a Medicare Advantage HMO or PPO Plan with prescription drug coverage get all their Medicare-covered health care from the plan, including prescription drugs.

Part A Hospital Insurance

People with Medicare who are inpatients of hospitals or skilled nursing facilities (SNF) during covered stays may receive drugs as part of their treatment. Medicare Part A payments made to hospitals and skilled nursing facilities generally cover all drugs provided during a stay. Under the Medicare hospice benefit, people receive drugs that are medically necessary for symptom control or pain relief. Part B can pay hospitals and SNFs for most categories of Part B-covered drugs if a person does not have Part A coverage, if Part A coverage for the stay has run out, or if a stay is not covered.

Part B Medical Insurance 

Medicare Part B covers a limited set of drugs. Medicare Part B covers injectable and infusible drugs that are not usually self-administered and that are furnished and administered as part of physician service. If the injection is usually self-administered (e.g., Imitrex) or is not furnished and administered as part of a physician’s service, it may not be covered by Part B. Medicare Part B also covers a limited number of other types of drugs as shown in the attached chart.1 (Regional differences in Part B drug coverage policies can occur in the absence of a national coverage decision.

Part D Prescription Drug Insurance

Part D-covered drugs are defined as drugs available only by prescription, used and sold in the United States, and used for a medically accepted indication; biological products; insulin; and vaccines. The definition also includes medical supplies associated with the injection of insulin (syringes, needles, alcohol swabs, and gauze). Certain drugs or classes of drugs, or their medical uses, are excluded by law from Part D coverage. While these drugs or uses are excluded from basic Part D coverage, drug plans may choose to include them as part of supplemental benefits, not covered by Medicare.

To learn more about Determining Drug Coverage for Original Medicare, click here: https://bit.ly/468iWmy 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