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Billing and Coding Tips For Opioid Use Disorder (OUD)

Harold Gibson

The Opioid Treatment Programs Medicare Billing and Payment fact sheet received an update from the Centers for Medicare & Medicaid Services (CMS) back in December of 2020, and it includes new billing and coding policies to use in 2021 when dealing with opioids use disorder (OUD).

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Topics: pain management billing, Opioids Use Disorder billing

Medical Coding Help: How-To Guide to Modifier 22

Harold Gibson

Medical coding modifiers are two characters that are appended to HCPCS Level II or CPT codes, offering more information about the medical service, supply involved, or procedure without changing the code’s meaning. When procedures go beyond the normal range of complexity, sometimes you may need to use a modifier. In this case, modifier 22, which is for “Increased procedural services,” maybe the right choice. However, a difficult procedure isn’t enough to add the modifier to the procedure code.

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Topics: modifier 22

Five Common Myths About Out-of-Network Ambulatory Surgery Center

Harold Gibson

Should you consider running an out-of-network ambulatory surgery center? While it may not work for everyone, it’s not as crazy as you might think. Plenty of myths have circulated surrounding out-of-network ambulatory surgical centers, yet the truth behind those myths shows that there are some key opportunities available if you do decide to continue with out-of-network offerings.

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Topics: Out of Network Ambulatory Surgery Center

Helpful Topics for Marketing Medical Practices in 2021

Patrick Dougherty

When it comes to marketing your clinic or other medical practice, you already know you need an active website and social media pages. But how do you keep those pages relevant without running out of content ideas? Here are a few ideas of what medical practices should be blogging about on their websites in 2021.

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Topics: Medical Practice Marketing

How Medical Practices Can Avoid Medicare Fraud and Abuse

Harold Gibson

According to data from 2016, CMS spent around $1.1 trillion on coverage for approximately 145 million people across America, yet $95 billion of that constituted improper payments that were connected to fraud or abuse. Unfortunately, it’s estimated by the FB that fraudulent billing constitutes between 3-10 percent of total health spending, a huge driver of waste and inefficiency.

Unfortunately, mistakes that lead to administrative areas like incorrect billing or even upcoding claims can both lead to charges of Medicare fraud and abuse for your medical practice. This can result in legal consequences like being excluded from federal healthcare programs, and could even lead to the loss of professional license in some cases. Some of the laws governing Medicare fraud and abuse include the Social Security Act, United States Criminal Code, Physician Self-Referral Law, False Claims Act, and the Anti-Kickback Statute.

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Topics: Medicare farud

About this blog

A place for physicians and other healthcare stakeholders to share and discover information about everything related to running efficient medical practices.

Established in 2002 by a group of physicians, we are a national provider of medical billing services to group practices, clinics, and individual physicians. We also specialize in provider credentialing, payer contract reviews, and medical coding for a wide range of clients - from solo practitioners to multi-site, multi-specialty practices.

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