The Medicare hospice benefit provides for two 90-day benefit periods. After that, it provides for benefit periods of 60 days, with no limit on the number of benefit periods. In order for a patient to remain eligible for the Medicare hospice benefit, the patient’s condition must continue to meet the Medicare hospice eligibility criteria. This
“Brain MRI with contrast” is specific enough to code. However, it could leave the coder to ask, “were there any non-contrast images performed?” When contrast is administered to a patient, images are performed both before and after the contrast is administered. The codes 70552 and 70553 indicate the imaging performed after the contrast is administered.
Covering all elements for a CPT code 99205 take time, but often, that is where the process ends. There are also questions relating to the nature of the medical decision making. Was the level of detail and complexity in the element of the visit sufficiently high? Then there is the question relating to time. Did
Postoperative visits often require evaluation and management (E&M) services in addition to postoperative care. Determining the E&M service level for each component of the visit and assigning that component to the appropriate payment (i.e. surgery payment or new payment) is the challenge. Modifier 24 describes a post-operative E&M service that is eligible to support a separate payment
Prior authorization is an important part of the healthcare process. Before a patient receives certain services, procedures, medications, or treatments, an insurance company may require approval first. This review helps the payer decide whether the requested care meets its coverage rules. But what exactly is prior authorization, and why is it required? In simple terms,
A National Provider Identifier (NPI) is an important part of healthcare administration in the United States. It gives healthcare providers and organizations a standard identifier used for billing, electronic healthcare transactions, credentialing, and communication with health plans. An NPI is a unique 10-digit number, but getting one requires accurate information. Errors in the application, provider details, or
When a patient is injured in a motor vehicle accident, Personal Injury Protection (PIP) insurance can help cover eligible medical expenses. For healthcare providers, understanding Florida’s PIP requirements is important because even medically necessary treatment can face reimbursement problems if claims do not meet these requirements. One key Florida PIP Insurance requirement is the 14-day
The 99213 CPT code is commonly used for office or outpatient visits with established patients. It applies when a physician or other qualified healthcare professional provides a medically necessary service that meets the requirements for this level of E/M care. Knowing the 99213 CPT code description, documentation requirements, medical decision-making (MDM), and time rules can help providers choose the
CPT Code 88305 is commonly used to report certain surgical pathology services for preparing and examining tissue specimens. Correct coding is important because even small billing errors can lead to claim denials, payment delays, or incorrect reimbursement. Pathology practices may face issues such as choosing the wrong code, reporting incorrect units, billing the same service more
Billing is essential to the financial health of an ambulatory surgery center (ASC). When claims are coded incorrectly, documentation is missing, or insurance details are not verified, payments can be delayed and revenue can be lost. Professional ASC billing services help reduce these problems by improving billing accuracy, managing claims, following up on unpaid accounts, and finding
Claim denials can quickly disrupt a mental health practice’s cash flow. A denied claim means delayed payment, extra administrative work, and more time spent fixing billing issues instead of focusing on patient care. The good news is that many mental health claim denials can be prevented. Simple steps such as verifying insurance information, using the correct codes, completing documentation,
A denied laboratory claim can mean delayed payments, extra rework, and lost revenue. Even a small error in patient information, insurance eligibility, coding, documentation, or claim submission can cause a claim to be rejected or delayed. Learning how to reduce laboratory claim denials starts with preventing these errors before claims are submitted. Accurate insurance verification, correct coding, complete
Physician billing errors can cause claim denials, payment delays, lost revenue, and extra work for staff. Simple mistakes in patient information, coding, documentation, or claim submission can prevent a practice from getting paid on time. A clear and consistent billing process can help identify errors early and reduce avoidable payment problems. This blog explains how
Spine surgery billing is complex, and even a small mistake can lead to denied claims, delayed payments, and lost revenue. With multiple procedure codes, strict payer rules, and detailed documentation requirements, getting every claim right can be challenging. Insurance companies also carefully review spine surgery claims to ensure they meet medical necessity guidelines. Learning How
Accurate OB/GYN billing is essential for keeping your practice financially healthy. Even a small coding or documentation mistake can result in claim denials, delayed payments, compliance issues, and lost revenue. Because OB/GYN practices provide everything from preventive care and prenatal visits to labor, delivery, surgery, and gynecological services, billing can be more complex than in many other specialties. On
