Medical coding and billing

What Type of Education Is Needed for Medical Billing and Coding?

Pursuing a career in medical billing and coding can be one of the most rewarding experiences in your life. This is a serious and complex field that is becoming more and more competitive. You don’t have to be a doctor or a nurse to help thousands of patients, because you can contribute quite a lot […]
Modifier 59 Separate Is Key

Solve Your 5 Biggest Modifier 59 Problems by Focusing on ‘Separate’

If you’re using Modifier 59 to get paid for multiple procedures, auditors are watching you. Modifier 59 has been on the OIG’s (Office of the Inspector General) radar for a while now, and because of consistent misuse and abuse, it will likely stay that way. Modifier 59 allows you to unbundle — separately report and […]
Medical Credentialing Doctor With Credentials

Medical Credentialing: What Is It & Why Is It Important for Reimbursement?

Without proper medical credentialing, a medical practitioner legally cannot work at a hospital or partner with insurers. Having medical staff credentialing training is crucial to ensure a new physician or practitioner is allowed to see patients, receive insurance reimbursements, and hospital privileges. Fail to attain on-time credentialing and the new staff will fail to meet […]
abn form

Medicare’s ABN Form: Top 10 Mistakes You’re Making (and How to Fix Them)

Using Medicare’s ABN form, Advance Beneficiary Notice might be a routine part of your job, but are you sure you’re doing it correctly and compliantly? Providers and staff who treat Medicare patients must know exactly how and when to issue a CMS ABN form to avoid costly write-offs and penalties. If you’re like most providers […]
Documentation Checklist Bulletproof Your Claims

Documentation Checklist Can Bulletproof Your Claims

Provider documentation is your only defense if you’re faced with an audit. It must be rock-solid to support the claims you submit to payers. But how can you ensure this happens when each clinician has his or her own style and perspective when documenting a patient encounter? The answer is good basic, defensible documentation. Here […]
Incident-to Billing

Incident-to Means You Must Have Employment Relationship, or You Lose on Pay

Set up the wrong employment relationship with your nonphysician practitioners (NPPs), and you’ll forfeit the ability to bill their services incident-to your physicians and miss out on an additional 15% of their reimbursement. Or worse, you could bill incident-to incorrectly and get targeted for an audit and be required to pay back all the reimbursement […]
Ortho Management

Ortho Management (97760) Billing

Can an orthopedic practice bill for orthotic management? One of the most commonly asked question is, “Can I bill 97760?” If you are an orthopedic practice, you really can’t. This is because it should always be a therapy service, and it has to be under a therapy plan of care. If your physician asks an […]
60-Day Rule Timeline

Avoid Tripping Over the 60-Day Rule Timeline … Know When to Start the Clock

The relatively new 60-Day Rule affects all Medicare and Medicaid providers regardless of specialty, size or type, and nailing down the exact date to begin your 60-day countdown is one of the most confusing compliance aspects — although other rule components can easily trip you up as well. The rule may seem straightforward — you […]
Medicare Overpays

Medicare Overpays Billions on E/M Claims

According to a May 2014 report based on 2010 data, HHS is claiming Medicare overpaid $6.7 billion in E/​M payments to providers. The Inspector General’s report, released on May 29, 2014 estimates that 21% of the $32.3 billion spent on E/​M services in 2010 are overpayments.  This data is based on 657 Medicare claims. Although […]