Helping Medical Practices Make More Money

In July, the proposed initiatives for the 2019 Medicare physician fee schedule was announced by the Centers for Medicare & Medicaid Services (CMS), and the officials announced that one of their goals was to work on easing the administrative burden on providers. According to Seema Verma, the CMS administrator, one of the things that she constantly heard as she traveled the country and visited clinicians in various care settings was that “…time spent on paperwork is time away from patients…” After hearing this story repeatedly, CMS is working to make some changes that will improve the lives of providers while improving access and quality for patients. Here’s a closer look at some of the proposed billing and coding changes you may see for 2019. 

With the new 2019 ICD-10-CM code set now available, we know that there have been more than 740 different changes. More than 30 of the changes for 2019 actually apply to Obstetrics and Gynecology (OBGyn) correction, from changes and updates to coding multiple gestation pregnancies to coding for obstetric surgical wound infections. Since these new codes need to be implemented for dates of service beginning on the first of October in 2018, it’s important for your OBGYN practice to become familiar with them now so you’re ready to begin using the newest, updated codes. Here’s a closer look at some of the relevant changes to the ICD-10 codes for your OBGYN practice.  

In recent months, the CMS has increased its Recovery Audit Contractor (RAC) efforts to identify over payments and other “outliers.” Other payers are following suit, thanks to more sophisticated data analytics tools to identify billing errors and discrepancies as audit targets. If you receive a notice for an audit, what should you do?

Analysis by Change Healthcare  in 2017 found that out of the approximately $3 trillion in medical claims that were submitted in 2016, nearly $262 billion  were  denied initially. While it’s best to prevent denials as much as possible, when you do have denials you can’t afford to let them slip through the cracks or your practice will lose a significant amount of revenue. Here are a few helpful tips you can use to successfully appealing a medical claim denial to ensure you’re getting paid for the services you provided.

Your medical billing processes are one of the most critical functions in your orthopedic practices. Proper orthopedic billing and coding process keep revenue flowing in with minimal delays, reducing cash flow problems and reducing stress for your practice. Denials can be one of the most significant issues orthopedics practices face and failing to take measures to prevent denials can be very costly for your practice. To minimize the risk of denials, here are several billing and coding tips your practice needs to follow.