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What Does 2021 Hold for Healthcare RCM

Details: Healthcare is one of the industries that experienced the most upheavals in 2020. The COVID-19 pandemic has thrown up urgent needs and new challenges for revenue cycle management (RCM), which will make reliable medical billing and coding services all the more important. Let’s take a look at the major challenges and predictions for RCM in 2021, according to recent reports.

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Health Risk Assessment Codes and How to Use Them

Details: Starting January 1, 2017, medical coding companies began using new codes to report administration and scoring of a patient-centered health risk assessment and a caregiver-focused health risk assessment. Health risk assessment tools evaluate a person’s risk of developing a disease. Primary care physicians (PCPs) routinely use these tools which have the potential to prevent chronic disease.

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Eligibility Verification Health Insurance Eligibility

Details: Eligibility verification is one of the challenging tasks faced by healthcare facilities. This challenge has become even greater with changing insurance rules and guidelines, and the flood of newly insured patients and patients who are changing plans.

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Telemedicine Coding and Billing during the COVID-19 Pandemic

Details: G2012 – Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services. Guidelines for billing Medicare virtual check-in codes: Call must be initiated by the patient; Patient does not have to be established (during the COVID-19

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Home Health Services

Details: Mobile health devices and telehealth platforms are two recent approaches to health management designed to meet the needs of seniors and improve social and clinical outcomes at senior living facilities and long-term care facilities. With home health services, seniors can stay at home instead of in a hospital or a skilled nursing facility.

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February Is American Heart Month

Details: Focusing on cardiovascular health has always been an important concern. The federally designated event generates wide significance particularly this year; due to the impact of the COVID -19 pandemic on the public heart health – including potential harmful effects on the heart and vascular system, according to recent research.

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ICD-10 Codes for Social Determinants of Health – Latest

Details: The 2014 Country Health Rankings report has found that nearly 80% of a person’s health is influenced by non medical issues such as food, housing, transportation, and the financial means to pay for medications, utilities and other services. SDOH ICD-10-CM codes

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Documenting and Coding Cerebrovascular Disease

Details: When reporting cerebrovascular diseases, physicians need to provide accurate documentation and the correct ICD-10 codes to describe the patient’s true health.

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Procedure Codes and Guidelines for Reporting Spinal Cord

Details: SCS is covered by most health insurance plans, including Medicare, private payers, and most workers’ compensation programs. Services provided for any given diagnosis must meet all of the general requirements for medical necessity as stated in CMS payment policy manuals, CMS national coverage determinations, and Medicare payment rules.

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Urinalysis Medical Billing Guidelines and Procedure Codes

Details: Emblem Health uses different types of commercially available claims review software to support correct coding of claims. Their 2015 payment policies support bundling CPT code 81002 and CPT code 81003 (Urinalysis by dip stick or tablet reagent) when reported with an Evaluation and Management (E/M) service (e.g., CPT codes 99201-99205, 99211

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Medical Codes for Documenting and Coding Schizophrenia

Details: When documenting schizophrenia, psychiatrists and other mental health specialists must include the associated symptoms, diagnosis screening tests and treatment procedures performed using the correct medical codes. For correct coding, documentation should identify whether the patient’s schizophrenia is chronic or an acute exacerbation.

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An Overview of Medicare Billing for Well Woman Exam

Details: Services such as shots that can ensure better health and prevent health issues. Education that will enable the patient to make correct health decisions. A physical examination is a key component of an annual Well Woman Visit and the components of this exam may vary in keeping with the patient’s age, physician preference, and risk factors.

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CMS Expands Medicare Coverage with 11 New Telehealth Services

Details: The Department of Health and Human Services (HSS) recently extended the duration of the public health emergency by 90 days, to expire Jan. 21, 2021. In addition to keeping track of newly added telehealth services, physicians should also be aware about the Medicare-covered telehealth services that CMS proposes retain permanently and those that

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ICD-10 Codes for Reporting Five Common Pulmonary Diseases

Details: Pulmonary diseases are one of the most commonly reported health issues in the United States, and the pulmonary medical specialty focuses on the prevention, diagnosis, and treatment of conditions that affect the lungs and respiratory tract. These diseases affect any organ inside your body that is associated with the breathing process.

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Insurance Eligibility Verifications And Pre-Authorizations

Details: Most claim denials are due to not properly verifying benefit information prior to services being provided. Insurance eligibility verification and prior authorization is the first and vital step in the medical billing process. Insurance verification process is crucial for all encounters, whether inpatient, outpatient or ambulatory care.

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World Health Day 2021

Details: The World Health Day celebration aims to create awareness of a specific health theme to highlight a priority area of concern for the World Health Organization. Every year, this day brings light to important health issues such as mental health, maternal and child care, and climate change.

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Importance of Insurance Verification Services in

Details: A health insurance verification specialist, also called insurance verifier, plays a big role in the health insurance system. These professionals work with patients, complete paperwork, and verify patient information with the insurance carrier to maximize reimbursement and facilitate revenue cycle improvement. The service includes verification of:

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Know the Rules to Report Remote Patient Monitoring (RPM

Details: While CPT code 99091 (Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of

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Health Insurance Verification Eligibility Verification

Details: Taking proactive steps to verify patient health benefits is essential for every medical practice to prevent denials and delays in payment. An established medical billing company based in the U.S., Outsource Strategies International (OSI) can take care of your health insurance verification tasks, helping you save time and money as you focus on patient care.

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New Diagnostic Codes for Substance Use Disorders and ARFID

Details: The National Center for Health Statistics (NCHS), the federal agency responsible for the use of the ICD-10 in the United States, recently released an updated version of the ICD-10-CM, the HIPAA-adopted code set for medical diagnoses used by medical providers, insurers, and health …

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March is National Kidney Month

Details: World Kidney Day was held this year on March 8 to emphasize the importance of women’s health and specifically, their kidney health. The theme of World Kidney Day 2018 was – “Kidneys & Women’s Health: Include, Value, Empower.” Chronic kidney disease (CKD) is often detected when blood or urine tests are carried out for another reason.

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Coding and Billing Telepsychiatry Encounters during the

Details: Health Behavior Intervention, Family without patient (96170, 96171) Telehealth Psychological and Neuropsychological Testing Services. CMS telehealth codes for Psychological and Neuropsychological Testing, which are temporary additions for …

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Why HIPAA is Important for Medical Billing OSI Blog

Details: Health information which can help to identify a person such as name, telephone number and email ID, photographs, health plan number, medical record number, license number, social security number, and dates are protected. No Unauthorized Access.

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Prior Authorizations – Current Challenges and Solutions

Details: Health insurance carriers require prior authorization (PA) as a condition of payment for many services. Payers use PA to determine if certain medications, products, treatments or services are medically necessary before they are prescribed/rendered to beneficiaries.

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CMS' Coding Rules for Transition Care Management

Details: Codes 99495 and 99496 are used to report physician or qualified non-physician practitioner care management services for a patient following the patient’s discharge from an inpatient hospital, partial hospital, observation status in a hospital, skilled nursing facility/nursing facility, or community mental health center to the patient’s

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Telehealth expansion for Medicare Patients in COVID-19 crisis

Details: The Centers for Medicare and Medicaid Services (CMS) has expanded Medicare’s telehealth benefits during the COVID-19 public health emergency under the 1135 waiver authority. Effective for dates of service starting March 6, 2020, the new telehealth policy will allow physicians to receive reimbursement for providing telehealth services to

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Coding and Reporting Pediatric Preventive Care Services

Details: Changes in Medicaid, the Children’s Health Insurance Program (CHIP) and new rules governing employer-sponsored and marketplace insurance plans have improved access to necessary health care for children and young adults over the years. Preventative care protects children against different types of diseases and infections, and allows physicians

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"Medicare for All"

Details: Improving health care in rural and underserved communities through providing a special projects fund devoted to the building and staffing of new health care facilities in rural and underserved areas. This new proposal also provides opportunity to negotiate as a big group against the pharmaceutical companies to bring down those prices.

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How to Improve a Doctor’s Front Office Efficiency OSI

Details: The front office is a very important aspect of your medical practice and crucial to its success as it sets the tone when the patient arrives. Efficient front office staff enhances the patient experience and reduces wait times, which can make a big difference to …

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Importance of Taking Time to Educate Patients on their

Details: The world of health insurance is complex and navigating the information and changes is a major challenge for most people. When it comes to dental insurance, the landscape is forever evolving. Insurers offering standalone dental plans are moving to partner with health …

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Key Measures to Improve HEDIS Reporting Efficiency

Details: Health plans can work with providers to help them improve EHR documentation. HEDIS coding support can ensure coding to the highest level of specificity. This is important not only for accurate billing, but also to provide quality healthcare. To ensure good medical records, health plans providers should ensure: Accurate and complete documentation

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ICD-10 Code to Report Multisystem Inflammatory Syndrome in

Details: As new information emerges regarding COVID-19, providers need to be meticulously following coding and billing guidance and regulations from the CDC, AMA, and other official organizations. Reporting COVID-19-related conditions on health care claims is much easier with the help of an experienced medical coding and billing company. Accurate COVID

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Coding Chronic Obstructive Pulmonary Disease in ICD-10

Details: A chronic cough is generally the first sign of COPD and as the disease progresses, the airways narrow and usually leads to pulmonary emphysema. Often triggered by smoking, it could become the world’s third most common cause of death in 2030, according to estimates from the World Health Organization (WHO).

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National Children’s Dental Health Month Observed in February

Details: The campaign is a strong platform that brings together dental health professionals, parents, and teachers to give children the best start on oral health. Tooth decay or dental caries is one of the most common diseases affecting children (aged 6 to 11 years) and adolescents (aged 12 to 19 years) in the United States.

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CMS expands Coverage for Phone Assessment and Management

Details: There’s good news for psychologists and other qualified healthcare professionals who provide phone consultations. During the COVID-19 public health emergency, the Centers for Medicaid and Medicare Services (CMS) will reimburse many audio phone-only behavioral health and patient education services.

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Spread Awareness about Important Health Issues this World

Details: Comprising more than two-thirds of the health workforce in the WHO Western Pacific Region, nurses play a critical role when it comes to responding to health needs in all settings. The 2020 WHD campaign is the perfect opportunity to advocate for commitment and resources to strengthen the nursing and midwifery workforce, improve their education

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BC Advantage Magazine May Edition Features OSI’s Article

Details: A reputable medical billing and coding company, Outsource Strategies International (OSI)’s article “How the COVID-19 Pandemic has Affected Mental Health” has been featured as the cover story of the BC Advantage Magazine, the highly acclaimed CEU-approved national online healthcare publication.Written by the company’s Senior Group Manager, Natalie Tornese, CPC, the …

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Documenting Preventive Medicine Services with CPT and ICD

Details: A unique medical specialty recognized by the American Board of Medical Specialties (ABMS), preventive medicine services or well visits aim at protecting, promoting, and maintaining health and well-being and preventing disease, disability, and death for …

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World Oral Health Day on March 20

Details: Oral health and dental hygiene is an important part of a person’s overall health and well-being. Poor dental hygiene can lead to different types of dental cavities and gum diseases, and has a direct link to other medical conditions (heart disease, cancer, and diabetes) as well. Following proper oral hygiene habits (like flossing, brushing and

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Billing and Coding for Physician Home Visits

Details: The specific home services performed could be provided by a visiting nurse or home health agency. With OIG and many CMS contractors auditing home services (CPT codes 99341 through 99350) billed to Medicare, participating physicians should understand the …

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Podcast Physical Therapy Services via Telehealth

Details: The basics of CMS guidance for PTs during the public health emergency (PHE) are as follows: PTs in private practice are eligible to bill Medicare for certain services provided via telehealth. Services that started as of March 1, 2020, and are provided for the duration of the PHE are eligible.

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Podcast Insurance Verification for Mental Health

Details: 00:45 Medicaid and Medicare Coverage for Behavioral/Mental Health Treatments. Most standard health insurance plans will provide coverage for some form of addiction treatment. Behavioral medicine billing requires expertise in different areas – verification of benefits and …

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World Kidney Day to be Celebrated on March Twelve

Details: Every year, March 12 is observed as “World Kidney Day (WKD)”worldwide. Held on the second Thursday in March every year, the global campaign aims to raise awareness about the importance of our kidneys to overall health and to reduce the frequency and impact of kidney disease and associated health problems worldwide.

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Strategies to Overturn and Prevent Medical Necessity Denials

Details: State departments of insurance and the Affordable Care Act (ACA) have granted consumers the right to an independent, external third level appeal of adverse coverage determinations by their health plans for issues such as medical necessity.

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How Insurance Verification Supports Behavioral/Mental

Details: Most standard health insurance plans will provide coverage for some form of addiction treatment. Behavioral medicine billing requires expertise in different areas – verification of benefits and eligibility, billing, and collections. Unlike other specialties, medical billing for behavioral & mental health especially substance abuse, is

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Observe October 2019 as National Dental Hygiene Month

Details: The awareness month campaign aims to bring together thousands of health professionals, educators and other healthcare providers to promote the benefits of good oral health among children and adults. The 2019 campaign is focusing on four routines that can help people maintain healthy smiles and these include – brush, floss, rinse and chew.

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World Mental Health Day

Details: The event also gives mental health workers, physicians, nurses and other professionals a chance to reduce the stigma associated with mental health problems, dispel mental health myths and help people recognize when their friends or family members may need to seek treatment.

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Notable Cardiovascular System CPT Code Changes in 2021

Details: In 2021, both the Category I section and Category III section of the CPT code book feature new codes in the Cardiovascular System section to accommodate innovation, new technology, and development of digital health solutions.

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