A single ICD-10 code, a missing modifier or a misclassified procedure intent can shift a colonoscopy from a fully covered preventive service to a medically necessary diagnostic one, which could change ...

The success of price transparency initiatives requires that prices be defined using a common payment methodology. In this article, we explore how coding schemas and pricing approaches varied in five ...

Medical coding translates health care services into standardized codes (such as CPT, ICD-10-CM, HCPCS) for insurance billing, directly determining physician reimbursement based on documentation.

New AI-powered solution within Flow by Innovaccer codes 80% of encounters autonomously in seconds, tackling coder shortages, revenue leakage, and rising cost per encounter SAN FRANCISCO--(BUSINESS ...

Programs and services required to use EVV are defined in Title 1 of the Texas Administrative Code (1 TAC) Part 15, Chapter 354, Subchapter O, Electronic Visit Verification, Sections 354.4005 Personal ...

Physicians deserve to be paid for the medical care they provide. Learn more with the AMA about the CPT coding errors to avoid. Government and private insurers’ audits have revealed unfortunate cases ...

The Centers for Medicare & Medicaid Services (CMS) issued updated guidance on the use of 340B modifiers for providers and suppliers participating in the 340B Drug Pricing Program and who bill ...

covered by a third party; covered under the Texas Medicaid State Plan; included in the nursing facility (NF) vendor payment; or included as NF add-on services. Note: If a recipient wishes to keep DME ...

If you’re preparing for the CBCS certification this year, the rules have changed under your feet. As of late 2024, the exam no longer permits physical coding manuals, forcing candidates to rely on ...

WASHINGTON – Noridian Healthcare Solutions has published an update for billing custom-fitted orthotics when no custom fitting is completed with no off-the-shelf equivalent available. “Due to recent ...