In Coding
May 14th, 2018
Managing denials is more difficult in 2018 than it was in 2005, 2000, or 1998. Not because practices are necessarily receiving more denials from payers but because unlike the early to mid-2000s and 1990s, we are now posting payments via auto remit programs, so denials and underpayments get automatically applied without a coder/biller questioning the ...
As payers like Aetna, ANthem, Cigna, Humana, UHC, SelectHealth, Blue Cross/Blue Shield embrace telehealth and establish their own programs, major healthcare networks are also reaping benefits from the exploding technology. Large networks like Kaiser Pemanente, Geisinger, Cleveland Clinic, and UPMC Health Plan are incorporating telehealth not only for outpatients but for inpatients. In an article ...
Oct 1st, 2016
The guidelines payers impose can affect the codes they allow you to bill for services. Question: I appreciated your spot-on answer in the August issue of Healthcare Business Monthly to the question “What Can I Do if Payers Don’t Follow CPT® Guidelines?” My question is: Are payers allowed to change the definition of a CPT® ...
Work together to get claims payment issues resolved. If you are a coder who works for a large payer organization, your day-to-day work looks different than that of a coder working for a provider. I’ve worked for both the provider and payer sides, and I’ve been on both sides of a medical record request. It’s no fun ...
In CMS
Oct 7th, 2015
Despite successful testing, claim transmission problems may persist as ICD-10 continues to be implement. The Centers for Medicare & Medicare Services (CMS) is anxious to resolve issues as quickly as possible. Report any issues directly to CMS here, by filling in the form. I-10 Transmission Troubles? CMS Wants to Hear from You was last modified: ...