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OB/GYN Billing and Coding: How to Avoid Claims Denials

Harold Gibson

Within changes in Current Procedural Terminology (CPT) codes and the implementation of ICD-10, many OB/GYN practices have faced medical billing and coding difficulties that have increased claims denials and slowed the practice revenue cycle. OB/GYN billing and coding comes with unique challenges because of the voluminous claims filing that comes with a practice that covers Obstetrics, Anesthesia for procedure, Gynecology, and Family Planning. If you’re practice is dealing with excessive claims denials that are hurting revenue, here’s a look at several strategies you can use to avoid claims denials and start improving revenue for your OB/GYN practice. 

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Topics: OB/GYN billing

State by State Telehealth Coverage Update

Harold Gibson

Insurance companies and CMS will be expanding telehealth coverage, as well as refining the definitions of what constitutes telehealth care and provider qualifications and restrictions based on new laws. Here are some of the latest telehealth changes from state and federal lawmakers:

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Topics: telehealth coverage

Population Health Reimbursement: What Providers Need to Know

Harold Gibson

What is Population Health (PH)?

More than 50 percent of all deaths each year are caused by stroke, cancer and heart disease.Population health became a concern for providers and payers due to the need to rein in the incidence and subsequent costs of treating chronic diseases as well as a shift from fee-for-service to value-based care models. It has been recognized by CMS and others for some time that fee-for-service (FFS) is becoming unsustainable, whether from a financial or medical view. For example:

  • Chronic diseases account for 7 out of 10 deaths yearly among Americans.
  • Diabetes, one of the most common chronic illnesses, is the main cause for kidney failure, lower-limb amputations and blindness in adults between 20 and 75.
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Topics: population health

Mohs Surgery Coding: 8 Coding Tips to Overcome Any Challenges

Harold Gibson

Mohs Surgery Coding Challenges

For a dermatology billing team one of the biggest headaches can involve Mohs surgery coding. While there are only a few codes for these procedures, knowing when and how to use them as well as modifiers or add-ons requires more knowledge and expertise than simply thumbing through the code book.

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Topics: Dermatology Billing Service

Successfully Negotiating Payer Contracts for Value-Based Service

Harold Gibson

The reimbursement landscape is slowly but surely moving from fee-for-service to value-based in response to MACRA’s regulations, with their emphasis on quality of care, and the resulting changes in care delivery, as well as billing and coding. Major players such as Blue Cross and Anthem were reported to have paid close to 60 percent of their 2017 reimbursements through value-based contracts, with other payers moving in the same direction.

With CMS’s goal of fully 50 percent of payments coming through value-based contracts by 2018, its Quality Payment Program also moves this forward through incentive reimbursement based on outcomes. Looking ahead, Medicare payments to practices will either be increased or lowered up to 9 percent depending on value-added merits including outcomes.

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Topics: negotiate payer contracts, payer contract negotiations

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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