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The Elements of Critical Care

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Specific requirements must be met for treatment to be considered critical. There are two critical care care CPT codes, 99291 and 99292. 99291: 30-74 minutes of critical care provided to a patient on a single date. Reported per date of service. 99292: additional set(s) of 30-minute increments of [...]

ABA Services

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Autism, a neurodevelopmental disorder, is a complex disability affecting 1 in 68 children. It is now common for those diagnosed to follow a treatment plan. Some insurance policies require a treatment plan outlining the frequency and expected outcomes/goals for the services provided. State laws often require certain doctors, such [...]

Monthly Capitation Payment (MCP)

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A capitation payment is a fee or payment of a uniform amount per each person. In regards to nephrology groups, Medicare’s monthly capitation payment is paid to physicians and practitioners for most of the outpatient dialysis-related services they provide to end-stage renal disease patients. The payment amount will vary [...]

Transitional Care Management

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Transitional Care Management (TCM) is the service provided to a patient whose transition from an inpatient medical facility back to their home requires moderate or high-level complex medical decision making. Qualifying facilities for the patient’s inpatient medical stay include inpatient hospital, partial hospital, observation status in a hospital, [...]

Patient Billing and Collections

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There is strategy to making sure patient collections are as sufficient as possible. Here are some of the key components to increase patient billing while making sure your process is thorough and without neglect. Obtaining Patient Information The initial step to ensuring receipt of accurate patient collections [...]

The Elements of Medical Documentation

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Are you having claim denials due to insufficient medical records? Does your office have concerns about whether your record-keeping system is thorough? The point of a medical record is to enable safe, accurate, and thorough care for your patient. For insurance reimbursement, medical documentation needs to show adequate [...]

Telemedicine

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Current technology combined with the need to develop greater convenience and a broader spectrum in the healthcare industry has allowed for the incorporation of telemedicine into the medical field. Within the United States, hospital physicians began experimenting with telemedicine over 50 years ago. Currently, due to the transformation of [...]

Common Denials for Preventive Services

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Preventive services are the screenings, vaccinations, and counseling services provided to enable the prevention of disease and/or abuse. The most common insurance claim denials are due to inaccurate frequency of these services being billed, the services being provided within an invalid place of service, or the lack [...]

MIPS, Transitioning from PQRS

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With the “end” of PQRS, following Performance Year 2016, comes the transition to MIPS – the Merit-Based Incentive Payment System. MIPS takes effect for Performance Year 2017. MIPS evaluates the quality-of-care provided to patients. There are some notable differences between PQRS and MIPS, two of these being the range of [...]

When is it Appropriate to Use Modifier 25?

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25 Whether you’re a practitioner, medical biller or medical office staff, you’ve surely questioned if the modifier 25 was appropriate on your claim. Here is some basic information to know about modifier 25. Modifier 25 is defined as the modifier appended to an Evaluation and Management (E&M) service indicating [...]