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

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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...
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9 Strategies to Improve Pharmacy Revenue

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The US healthcare is evolving. To improve pharmacy Revenue the pharmacies need to be equipped with a better billing system.

Here are some challenges faced by pharmacies that cause billing errors and affect customer relations, revenues, and reimbursements:

  • Access to the patient’s eligibility at the time of service may be unavailable.
  • The staff may not be updated with information about various drugs, allergies, maximum dosage, billing system, rules, codes, and insurance clauses.
  • Claim denials due to unspecified codes put pharmacies at risk.
  • An increase in turn-around time, duplication of work, workforce shortage, and inefficient time and energy utilization of staff members in case of critical cases, could lead to billing errors.
  • Medical billing cannot process vaccine claims covered by pharmacy or medical benefits.
  • The pharmacy billing system is not scalable or flexible.
  • Incorrect CDM could result in underpayment, claims denials, and fines. Incorrect payments could affect revenues and budget planning.

9 Strategies to Improve Pharmacy Revenue

The efficiency of the billing department is critical to patient’s health-related issues. Here are some strategies that can improve the pharmacy revenue –

  1. The billing system needs to check for patient eligibility in real time. Comprehensive record sheets of the patients should be located centrally and should be available to the right party at the right time. Updating records should be done regularly. Record duplication should be completely avoided. This will minimize errors and will ensure better reimbursements.
  2. The coverage of all medical claims should be processed by the billing system. Claim submission and payment processing of products should be handled by the billing system.
  3. Automated billing systems will reduce routine and manual work and increase turnaround time. Intervention should be required in case of complex situations.
  4. Billing software should be updated with all the mandatory government codes and regulations and, medical and procedure information.
  5. The billing system should be able to process vaccine claims in real time. The providers of this service should know the amount for which they will be reimbursed including the co-pays and deductibles.
  6. All types of medical benefits should be provided by the billing system.
  7. Scalable systems will take the pressure off of the pharmacy’s billing staff. Investing in flexible systems can provide freedom in adjusting it to the organization’s practices.
  8. An effective revenue cycle can be facilitated by the billing system if it reconciles with the inventory system in real-time. This will reduce charge captures, billing errors, unaccounted inventories, and compliance issues.
  9. The CDM needs to be maintained and managed efficiently as it has details like billing units, dosage specifications, and drug prescriptions. This data should be maintained in the billing system so that all the charges generated by the pharmacy can be tracked.

To learn more about 9 Strategies to Improve Pharmacy Revenue click here: https://bit.ly/3QnvUXO, Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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