Medical Billers and Coders

  When performing outpatient procedures, many orthopedic surgeons operate in either ASCs or a hospital-based outpatient department (HOPD). Although some of the workflows and services offered may appear similar between the two, the background operations are substantially different from business and regulatory perspectives. An HOPD is owned by and typically attached to a hospital, whereas an ASC is considered a standalone facility. The goals of this study were to compare the utilization and cost of ASCs vs HOPDs. The difference between an ASC and HOPD specifically refers to the regulations that apply to the center; therefore, a “freestanding” surgery center can still be classified as an HOPD if it is within a 35-mile radius of the hospital and falls under the same financial and administrative contracts. Similarly, a facility can be operated by a hospital and still maintain ASC status if it is an independent entity financially and administratively with its own Medicare agreement. Furt

  Improper use of Modifiers for Podiatry Services can be the cause of claim denials just as not using a modifier can be. When using modifiers, make sure you clearly understand what the modifier entails. Sometimes, there are related services that the physician is performing, global periods to contend with, etc. Modifiers will clarify extenuating circumstances, which should allow for payment when they otherwise may not. If the insurance company denies a claim and you rebill it by simply choosing another modifier and hoping that is the correct one, this will usually end up creating additional problems. Insurance companies may have a time limit as to how long you can file an appeal. If you continually rebill incorrectly, then by the time you send in the claims and subsequently get denied again, you may run out of the appeal window. The appeal window generally starts when you submit the initial claim.  Medicare  explanation of medical benefits (EOMBs) will indicate whether you can appeal

  Diabetes self-management education/training (DSMET) is cost-effective and improves health outcomes as patients maintain better control of their A1C. Diabetes educators provide education/training services and enable  physicians  to provide comprehensive high-quality care for their patients with diabetes and those at high risk of developing diabetes. The primary care practitioner in DSMT  provides general medical care  and is responsible for overall care, including the coordination of medical specialists. Role of Primary Care Practitioner in DSMT Diabetes educators bring a unique skill set to the physician‘s practice and are important adjuncts to primary care. These educators: help patients with diabetes develop the skills for managing their illnesses. increase a practice‘s efficiency by assuming time-consuming patient training, counseling, and follow-up duties. serve as an extension of the physician‘s practice to enhance the quality of care delivered. Diabetes educators are

  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

  ASCs, bring revolution in surgical care who led to the establishment of affordable and safe outpatient surgery. Moreover, The ASC industry is ahead of the curve in identifying avenues for improving the delivery of health care. ASCs are a rare example of a successful transformation in healthcare delivery. Hence stakeholders must understand about ASCs and their benefits and growth factors of ASCs: What is ASC? ASCs are modern healthcare facilities that offer patients the convenience of having surgeries and procedures performed safely outside the hospital setting. The first ASC facility was opened in Phoenix by two physicians in 1970. These physicians saw an opportunity to establish a high-quality, cost-effective alternative to inpatient hospital care for surgical services. Benefits of ASCs Today, physicians are continually providing the impetus which helps in the development of new ASCs. Physicians have realized that they gain increased control over their surgical prac

  Medical Billing a Challenge for Struggling Primary Care Practices Medical billing is a complex process and it’s always been a reason for the struggle of primary care physicians. In addition, their practice is often overwhelmed with constantly changing information, including protocols and billing codes which makes the situation more challenging. When the covid-19 pandemic strains the U.S. healthcare system, primary care physicians were working to educate their patients, employ safety protocols, and handle large volumes of calls. This large volume of calls is creating administrative hurdles and operational challenges. Hence in response, many primary care practices are making changes to their  medical billing processes  to accommodate new patient needs. The recent release of the Medicare physician fee schedule final rule from the Centers for Medicare & Medicaid Services (CMS) contains new hope for struggling primary care physicians and you will get to know about it in the follo

  During the Public Health Emergency (PHE), The Centers for Medicare & Medicaid Services (CMS) used a combination of emergency waivers, regulations, and sub-regulatory guidance to offer healthcare providers the flexibility needed to respond to the pandemic. In certain cases, these flexibilities suspended requirements in order to address acute and extraordinary circumstances. Now, CMS is taking steps to continue to protect nursing home residents’ health and safety by announcing guidance that restores certain minimum standards for compliance with CMS requirements. We shared a recent update on the removal of temporary emergency waivers for nursing homes, inpatient hospices, ICF/IIDs, and ESRD facilities. Emergency Waivers for Nursing Home Restoring these standards will be accomplished by phasing out some temporary emergency declaration waivers that have been in effect throughout the COVID-19 PHE. These temporary emergency waivers were designed to provide facilities with the flexib