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Medical Billing Blog
Posted on October 8, 2014 by · Leave a Comment
Filed under: medical billing and coding  

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Medical Coding jobs are by far one of the most thriving job industries of all times. Qualified and experienced medical coding professionals are always able to draw a hectic monthly salary. Nowadays, almost all leading hospitals and top-notch health care centers outsource the works related to medical billing codes to reliable and reputed medical billing companies. This is the main reason why experienced professionals well versed with medical billing codes are always in huge demand. Read along to know more about medical coding jobs.

Medical Coding Jobs Requirements

One of the basic duties of a professional medical billing practitioner is to assist with the coding procedures of a patient’s medical documents. The doctors, after jotting down the medical notes of a patient’s treatment and diagnosis, will require the service of a qualified person. This is for transcribing these notes into the computerized format. The computerized data or medical billing codes are then used to maintain a consistent track regarding the patient’s health improvement and important schedules pertaining to future medical consultations.

Medical billing and coding services are required to deal with numerous insurance companies. The medical billing practitioners will ensure that all the medical billing services company are correctly reimbursed from the insurance companies. Adding to that, they will also do the prompt inquiries of the patient’s insurance claim appeals.

Are you looking forward to pursuing a lucrative professional career? Then medical billing and coding jobs will certainly be one of the best options for you. However, you should always remember that it is imperative to get the training and certification from acclaimed medical billing institutes. It is because eminent medical billing companies always look for people who have thorough knowledge about the nature of the job. You can see that the training you receive at medical billing institutes is a strong theoretical platform that enables you to step into the real profession. Once the training is completed, you will have to take up the Certified Medical Billing Specialist Exam or CMBS exam.

Though you can see that the pay is good, medical billing jobs come with many responsibilities. You should be passionate about the job if you want to be successful. It is important to have an eye for even the slightest of details. You should also have good patience and the ability to work under stressful conditions without losing your calm. Therefore, if you think you possess all these basic requirements, medical billing and coding may be the right career option for you.

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Lo, these many months now, practices have been ignoring ICD-10 and hoping it would go away.

It‘«÷s not.

CMS confirmed in March that the October 1, 2014 deadline was firm, so as of right now, you have approximately 1 year to get ready for the new code set.

Does that seem like a lot of time? It‘«÷s not.

I participated in a Tweet chat this morning with some leading experts on ICD-10, and one of them, Brad Justus, said that ‘«£Everyone should already have a budget and a detailed project plan and be well on their way to remediation.‘«ō

A Health Information Management Solutions Expert with significant expertise in ICD-10, Brad also said, ‘«£I am concerned that many are still not taking ICD-10 seriously and will have no resources available when they figure it out.‘«ō

Brad recommends that practices ‘«£have quality Project Management to make sure all tasks are completed by the right people at the right times.‘«ō

Another leading expert, Betsy Nicoletti, said in a recent blog post that ‘«£With the date for ICD-10 implementation a year away, it‘«÷s time to stop talking about ICD-10 and start learning ICD-10.‘«ō Appropriately, the title of her blog post was ‘«£A Little Less Conversation, a Little More Action,?ŠPlease,‘«ō which most experts thoroughly agree with.

Among the points Betsy makes in her blog post are that practices should:

– Send two staff members to one or two day ICD-10 training program. ?ŠA program with ICD-10 books. ?ŠLarger practices and multi-specialty groups will need to adjust this recommendation up.
– Coders without training in Anatomy and Physiology should take an on line course or community college course right now.
– Plan to train your clinicians later in 2014.
– Buy an ICD-10 book.
– Print out your ten most frequently used diagnosis codes.?Š?Š Try to code those diagnoses in ICD-10.?Š Can you?
– Select ten records that correspond to your most frequently reported diagnosis codes.?Š Based on the medical record documentation, can you select ICD-10 codes?
– Show your providers a few diagnosis conversions each week, focusing on codes that don‘«÷t have a direct crosswalk.
– Use specific ICD-9 codes. The transition will be much easier.
– Have cash on hand for the transition.

You can read the full list in her blog post, along with other useful articles on ICD-10.

Another excellent resource for preparing for ICD-10 is the website This site features useful articles every week on different aspects of ICD-10 prep. An article published last week discussed ‘«£How to improve clinical documentation,‘«ō including these useful tips:

If you’re creating a formal plan, there are five key steps to improving clinical documentation:

1. “Assess documentation for ICD-10 readiness.”
2. “Analyze the impact on claims.”
3. “Implement early clinician education.”
4. “Establish a concurrent documentation review program.”
5. “Streamline clinical documentation workflow.”

There are any number of other resources, and CMS offers multiple resources on its website, including checklists and recently posted recorded webinars on how to get started.

Don‘«÷t wait until it‘«÷s too late and your revenue will be seriously affected by the transition. As Brad Justus added in the Tweet chat this morning, ‘«£Please don’t bet your job or your facility on not being fully prepared for ICD-10; Start Now If You Have Not!‘«ō

If you have concerns about whether your medical billing team can guarantee that your revenue cycle management will be ready for ICD-10, contact today. We‘«÷ll be happy to help you with a smooth transition to ICD-10. Call us today at 800-966-9270 or email

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ICD-10 is just over 400 days away, yet many practices have not yet begun to plan for it. Here‘«÷s a review of the latest news and tips on preparing for this change that‘«÷s being called ‘«£the Y2K of healthcare.‘«ō

ICD-10 Could Cause Healthcare Reimbursements to Take a Hit
Becker‘«÷s ASC Review

Providers who are not prepared for the ICD-10 transition may see their bottom lines suffer, according to aMediGainreport. The?ŠHealthcare Billing and Management Association?Šrecently stressed the importance of being prepared for the change to ICD-10’s more granular code set. Holly Louie, chair of the organization’s ICD-10/5010 committee, testified before Congress that the economic stability of the country’s healthcare reimbursement system is hinging upon this successful switch‘«™ Read More

ICD-10 Budgeting: Do You Know How Much the Transition Will Cost?
ICD-10 Watch

The true cost of the ICD-10 transition may not be as easy to calculate as you think. Sure you can call healthcare vendors to get quotes on modifications to software and hardware, upgrades and purchases of new software, systems and equipment.

But that’s not the whole price. You need to get your best estimates of the following elements‘«™ Read More

61% of Providers Say ICD-10 Testing Will Take 9 to 12 Months
Becker‘«÷s ASC Review

A new?Šreport?Šfrom Qualitest Group shows that around 75 percent of healthcare organizations have not begun testing for ICD-10 despite the looming deadline for a full transition next year‘«™ Read More

ICD-10 Transition: Maybe It’s Time to Panic a Little
ICD-10 Watch

We are about 14 months away from the ICD-10 implementation deadline. Surveys report that healthcare providers are in various states of readiness. QualiTest Group?Šsurveyed more than 300 professionals?Šabout their ICD-10 testing plans. The two major findings are:

– Most respondents have either completed ICD-10 assessments or are in the process of assessments.

– 75 percent of respondents have not yet begun ICD-10 testing.

While starting sooner than later is important, this survey doesn’t raise too many alarm bells. It does report a great deal of planning and progress in the ICD-10 transition. Other surveys released in the past few months have found less preparation.

Perhaps a more troubling indicator is the amount of newly released literature that suggests there is an audience that hasn’t heard of ICD-10 implementation. If the healthcare industry is on its way to a smooth ICD-10 transition, we wouldn’t need so many guides to planning ICD-10 implementation. Read More

Physician Practice Costs for ICD-10: Clinical Documentation
ICD-10 Monitor

Physician offices are inching slowly toward ICD-10 ‘«Ų very slowly. A recent survey of 1,200 practices conducted by MGMA reveals that loss of physician productivity, staff efficiency, and changes to clinical documentation are still major concerns.

While MGMA and the physician community at large are reluctant to implement ICD-10 (and have raised many roadblocks to its progress), the organization‘«÷s May 16, 2012, letter to CMS provides valuable guidance regarding the six key areas of cost impact to watch.

MGMA advises ICD-10 will add significant costs for physician practices and clinical laboratories in these six areas:

  • – Staff education and training
  • – Business-process analysis
  • – Changes to ‘«£superbills‘«ō
  • – IT system changes
  • – Increased documentation costs
  • – Cash flow disruption

Read More

ICD-10 Transition: What It Takes to Work with Healthcare Payers
ICD-10 Watch

You could put off communicating with your healthcare payers until you submit your first ICD-10 coded claim Oct. 1, 2014. What could go wrong?

Early communication will help healthcare providers test the ICD-10 claims process and gain insight into how reimbursements will be affected after Oct. 1, 2014. That second part will help prepare for DRG shifts. This puts a price tag on procrastination. Read More

Fast Tracking ICD-10: Building the Action Plan
ICD-10 Monitor

It‘«÷s time to get geared up for ICD-10 by building an action plan. We just finished developing a budget for a large hospital system and found that the bulk of the budget will go to software applications, hardware upgrades, and education and training. These also happen to be three high-risk areas as it pertains to compliance.

Now we have to turn the impact assessment and gap analysis into the action plan. I am finding that working with hospital systems that have large steering committees with several sub-committees helps distribute the action items evenly. For example, every department will need education, whether in the form of simple awareness, fundamental instruction, documentation courses or in-depth training. By assigning this task to the education subcommittee, an organization can map out an education plan listed front and center in the action plan. I find that, for large health systems and hospitals, it is helpful to map out action items and milestones in an Intranet portal so every steering committee member and subcommittee chair can track progress along the way‘«™ Read More

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Big changes are occurring in health care, and to help you stay abreast of them, we‘«÷ve gathered the latest news that can affect your practice revenue. Below you‘«÷ll find articles on health insurance exchanges, collaborating with other practices to save money, getting tax breaks for your practice, online patient payments, and much more.

5 Ways Health Insurance Exchanges Could Impact Physician Income
Becker‘«÷s ASC Review

The Patient Protection and Affordable Care Act’s health insurance exchanges will open on Jan. 1, 2014, and likely have an impact on physician income, according to a?ŠMedscape News?Šreport.

The exchanges will be open online Oct. 1, 2013, designed to allow uninsured people to choose coverage for the next year. According to the report, primary care physicians and specialists could see:

‘«ů?Š?Š ?ŠLower reimbursement rates from insurance companies participating in the exchange
‘«ů?Š?Š ?ŠLess control over the number of patients from exchanges they see
‘«ů?Š?Š ?ŠProblems collecting out-of-pocket from exchange patients
‘«ů?Š?Š ?ŠPatients who aren’t familiar with following treatment regimens
‘«ů?Š?Š ?ŠFormation of narrow networks for insurers, which begin with hospitals and then decide how physicians are included with the potential for “cost profiling”

Read More

Collaboration Can Save Medical Practices Time, Money and Effort

Physicians can share front office staff and an electronic health record system. However, they need to prove integration efforts are legal to avoid antitrust violations‘«™
Read More

Patients More Willing to Pay Healthcare Bills Online
Becker‘«÷s ASC Review

In 2012, around 13 percent of the gross dollar volume of all patient payments was made online, according to “Trends in Healthcare Payments Annual Report: 2012,” a recent report by vendor Instamed. The figure is up from around 8 percent in 2010‘«™ Read More

How to Get Tax Breaks for Your Medical Practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them‘«™ Read More

Waste Not, Want Not: Billing Unused Drug Supplies

Physicians sometimes must discard an unused portion of a drug. If the physician (rather than the patient and/or facility) supplies the drug, Medicare may allow compensation for this ‘«£wasted‘«ō portion.

As instructed by the National Medicare guidelines for reporting drug waste found in the?ŠClaims Processing Manual, chapter 17, ?ļ 40.0, drug waste is reported?Šin addition to?Šthe drug administered‘«™ Read More

A Quick Guide to ‘«£Separate Procedures‘«ō

CPT?ę codes designated as ‘«£separate procedures‘«ō are considered to be incidental and bundled with any related comprehensive/major procedure when performed during the same session, through the same incision, and/or at same anatomic site. A separate procedure may be reported only if:

1. It is the only procedure performed,?Šor

2. It is unrelated to or distinct from other procedures performed during the same operative session (e.g., separate incision or site, performed on the ipsilateral/contralateral side, etc.).

Read More

For Some Post-Op Care, a Phone Call May Be All That’s Needed

Scheduling a call instead of an in-person visit could reduce patient no-shows, which would help physicians better manage patient loads and follow-up care‘«™ Read More

The Top Five Essential Tips for Successful Appeals
California Medical Association

How you present appeals to your carrier can make the difference between success and failure. AAPC‘«÷s Managing Editor?ŠG. John Verhovshek, MA, CPC,?Šrecently offered five tips for successful appeals in an article published by?ŠCalifornia Medical Association.

  1. – Be prepared
  2. – Write a proper appeal letter
  3. – Correct the claim before you appeal
  4. – Code only what documentation supports
  5. – Avoid obvious mistakes

Read More

Prompt Proper Assistant-at-surgery Payment

Successful coding and billing for surgical assistants depends on three principal factors:

  1. – Does the payer allow additional reimbursement for surgical assistance for the reported procedure?
  2. – Has the surgeon sufficiently documented the need for and role of the surgical assistant?
  3. – Has the proper modifier been appended to the claim?

Here are some tips and techniques for ensuring your assistant-at-surgery claims prompt proper payment‘«™ Read More

Advance: Appending Modifiers 50, 51, and 59
AAPC News/Advance

Modifiers are crucial to telling the story of a claim by identifying procedures that have been altered, without changing the core meaning of the code(s) submitted. AAPC‘«÷s National Advisory Board Member Relations Officer Nancy Clark, CPC, CPB, CPMA, CPC-I,?Š recently published an article in?ŠAdvance for Health Information Professionals, in which she expounded on the proper application of modifiers 50, 51, and 59. Ms. Clark provided examples, tables, and even comparisons between modifiers.

1. Modifier 50?ŠBilateral procedure?Šdescribes procedures or services that take place on identical, opposing structures (e.g., shoulder joints, breasts, eyes).

2. Use modifier 51?ŠMultiple procedures?Što show that the same provider performed multiple procedures (other than E/M services) during the same session.

3. Modifier 59?ŠDistinct procedural service?Šindicates a:

– Different encounter or session;

– Different procedure;

– Different site; or

– Separate incision, excision, injury, lesion, or body part.

Read More

15 Statistics on Surgery Center Accounts Receivable Days
Becker‘«÷s ASC Review

In all ASCs:
1. 0 to 30 days: 53.4 percent
2. 31 to 60 days: 17.2 percent
3. 61 to 90 days: 8.2 percent
4. 91 to 120 days: 5.4 percent
5. Over 120 days: 15.9 percent

The article also provides data on AR days In ASCs with fewer than 3,000 cases and ASCs with at least 6,000 cases. Read More

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That‘«÷s right‘«Ųmy medical billing service beats your inhouse billing staff. Well, not literally‘«Ųbut in the things that matter, yes, our third party billing service can beat inhouse staff hands down on most points.

Here‘«÷s why I say that:

1. You only pay for our billing services when you‘«÷re actually using them. You don‘«÷t have to pay us whether or not you have claims to bill, whether or not we are sick or on vacation. And you only pay us when you get paid. That‘«÷s a pretty efficient way to run your medical billing.

2. Our medical billers are highly trained and expert in medical billing. Medical billing is what our billers do, every day, all day. We hire only highly trained billers, and we make sure they stay up to date on their training. Plus, they learn from each other‘«Ųtheir colleagues in our offices across the country who are handling just about every specialty.

3. Our medical billers are up to speed on all the latest requirements and software. We make sure they‘«÷re up to date on HIPAA, CPT coding changes and other important legal issues. And they are trained on multiple software platforms. Because if we don‘«÷t, we are out of business.

4. Our medical billing staff will provide you with reports you can trust, and that have been proven to work for hundreds of other practices. We follow best practices across our multiple locations, and learn from what our experience managers throughout the company are doing. Reports are developed and refined to insure they are providing you with the information you need to manage your practice. And if you need different reports, tell us‘«Ųwe‘«÷ll work with you to get you what you need.

5. We save you all the hidden costs of hiring and maintaining a billing staff inhouse. ?ŠHiring and maintaining a billing staff has multiple hidden costs you probably don‘«÷t think about:

A. Medical Billing Specialist’s Employee salary

B. Medical Billing Specialist’s Employee benefits

C. Worker’s compensation


E. Healthcare insurance

F. Vacation, sick leave, etc.

G. Performance bonus

H. Computer hardware purchase & maintenance

I. Software purchase & renewal

Do what you do best. Let us handle the rest.

You didn‘«÷t go to medical school to learn how to manage medical billing staff; you wanted to treat patients. Why waste your valuable time on administrative details better outsourced and left to the experts?

Here‘«÷s what one of our customers said about making the change:

‘«£ made all the difference for my practice. They eliminated all the frustrations associated with insurance reimbursements and increased my revenues by 100%.‘«ō

Why not find out how you can reduce your headaches and increase your bottom line? Contact today at 800-966-9270 and talk to one of our practice revenue consultants about how we can improve your practice profitability.

We‘«÷d love to show you how we can beat the results your inhouse medical billing staff is getting.

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Medical billing service adsWhen you search for ‘«£medical billing services‘«ō on Google, it may seem like you‘«÷re being deluged with information‘«Ųand you may feel like you have no way to sort through what you‘«÷re seeing.

There are quite a few medical billing companies listed for any search‘«Ųso how do you find the right one for your practice? Here are a couple of tips for looking at Google ads:

1. Look for reviews. As you can see from our listing, we have more than 30 reviews from customers linked to our Google listing. These reviews give you a good idea of how well we‘«÷ve performed for practices like yours.

2. Notice what the ad says.?ŠOur ad plainly states, ‘«£Every Claim Paid. Guaranteed.‘«ō We put our guarantee in print, right at the top of our ad, because we mean it. And we stand by it.

3. Placement matters. Being one of the top ads on the left side of the page says that the company is large enough to commit some significant dollars to advertising‘«Ųand that‘«÷s a good thing if you want a medical billing service that will be around for a while (and you do). Having a medical billing service with resources and a commitment to the field will serve you in the long run.

Once you‘«÷ve called the number in the Google ad, notice a couple of things:

A. Does the representative on the phone seem to understand medical billing? If not, how can they match you with the service you need? If it‘«÷s a call center or the person just wants to close a sale without understanding your needs, beware. You want to deal with a medical billing service that understands and works to meet your requirements, and that starts with the first contact.

B. Does the representative give you a proposal in writing? Percentages and service level promises mean nothing unless they‘«÷re written down. Make sure you get all of your specified needs in writing in the proposal, so you know what the pricing includes.

C. Will the representative quote you real prices? In the beginning, of course, the rep needs to understand exactly what your needs are and how the medical billing service can meet them. But at some point the rep needs to be willing to quote you a price that includes what you‘«÷re looking for. And once you have a written proposal, you can compare that with what the services and price you are currently receiving. Otherwise, you don‘«÷t know what you‘«÷re comparing.

D. Can the representative answer your questions about denial rates, appeal success and other key performance indicators? Make sure you‘«÷ll be receiving the level of service that you need‘«Ųa high denial rate and low appeals success rate will slow down your revenue stream significantly. And how soon after claims are received by the medical billing service are they submitted? Data will help you choose the best revenue cycle management partner for your practice.

When you‘«÷re looking for the best medical billing service for your practice, be sure to consider these questions.

And for more tips on when and how to select the right medical billing service for your practice, download our white paper with checklists and useful advice now.

Or, call now at 800-966-9270 and we‘«÷ll be happy to answer your questions on improving your practice profitability.

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2013 OIG Work Plan: HHS Targets Three Areas
For The Record

From a coding perspective, mechanical ventilation, cancelled surgeries, and Medicare’s transfer policy take top billing in the OIG work plan for 2013.

Last October, the Office of Inspector General (OIG) released its work plan for fiscal year (FY) 2013, an event that sometimes can trigger anxiety among health care organizations. Published annually, the work plan outlines the OIG’s enforcement priorities, enabling health care facilities to better identify compliance risks and more accurately gauge their chances of meeting the requirements.

According to the OIG, the work plan is part of “a dynamic process, and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available. We assess relative risks in the programs for which we have oversight authority to identify the areas most in need of attention and, accordingly, to set priorities for the sequence and proportion of resources to be allocated.”

In creating the work plan, the OIG evaluates several factors, including mandatory requirements by law, regulation, or directive; congressional, Health and Human Services (HHS), or Office of Management and Budget requests and concerns; management and performance challenges facing HHS; collaborative work performed with partner organizations; and management’s responsiveness to results from previous reviews. Among OIG’s areas of focus for 2013 are coding related to payments for mechanical ventilation and cancelled surgeries as well as Medicare’s transfer policy.

Read More:


Cardiology: 93010 Is Sometimes the Right Choice on Cardiac ?ť?ŠCath ?ť?ŠDay

The Coding Institute

ECGs are bundled into cardiac catheterizations. But if you overlook opportunities to report ECGs on cardiac catheterization days, you could be shortchanging your practice. ?ť?ŠMedicare offers rules for reporting ECGs on the same date as cardiac catheterizations. The gist is that routine ECGs performed during cardiac caths are not billable in addition to the cardiac cath. But you may bill separately for diagnostic ECGs performed before or after the cardiac cath service. Here’s a closer look.

During cath: Medicare’s Correct Coding Initiative (CCI) manual, Chapter 11, Section I.4, indicates that because ECG monitoring is routinely used during cardiac catheterization, ECG codes aren’t reportable in addition to cardiac cath codes.

(The manual is available from the Downloads section at Coding/NationalCorrectCodInitEd/index.html.)

Note the Diagnostic Exception

Although ECGs that are an integral part of the cardiac cath aren’t separately payable, the patient may have diagnostic ECGs before or after the cath session. Those diagnostic ECGs are separately payable by Medicare when you append modifier 59 (Distinct procedural service) to the ECG code.

The CCI manual, Chapter 11, Section I.16, supports this by stating, “Cardiac catheterization procedures or a percutaneous coronary artery interventional procedure may require ECG tracings to assess chest pain during the procedure. These ECG tracings are not separately reportable. Diagnostic ECGs performed prior to or after the procedure may be separately reportable with modifier 59.”

Note: Don’t confuse standardized patient care with diagnostic ECGs. Some physicians will routinely order an ECG before and after a cardiac catheterization and/or interventional procedure. This is considered standardized patient care.

Helpful: If you’re having trouble determining whether the service performed meets the definition of diagnostic, consider the requirements listed in the National Coverage Determination (NCD) for Electrocardiographic Services (Section 20.15). The NCD manual is available by clicking the link for Publication 100-03 at Regulations-and-Guidance/Guidance/Manuals/Internet- Only-Manuals-IOMs.html.

Use the Appropriate Code for Diagnostic ECG

Once you’ve determined that a patient had a reportable ECG on the same date as a cardiac cath, you need to choose the correct code. For interpretation and report of a typical 12-lead diagnostic ECG performed in a facility, the appropriate code is 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only). Recall that to override the cardiac cath/ECG edit, you must append a modifier to the ECG code.

Tip: The code definition refers to “at least 12 leads.”?ō For proper coding, you should know that a “lead”?ō and an “electrode”?ō are not the same thing. For instance, providers may refer to 10 electrodes placed on a patient for a 12-lead ECG. To simplify, think of a lead as an electrical view or snapshot of the heart from a particular perspective, creating what the provider sees on the graphic representation. A combination of electrodes can provide a single lead.

The use of “at least”?ō in the 93010 code definition is also important because it means the code is appropriate for 12 or more leads. ?ť?ŠConsequently, 93010 is correct when documentation shows 10 electrodes for a 12-lead ECG or 14 electrodes for a 15- lead ECG because in both cases there are 12 or more leads.

Bottom line: On cardiac cath days, experts advise only coding ECGs ordered/documented as diagnostic and performed before or after the cardiac cath. Baseline screenings or monitoring ECGs are not considered diagnostic.


Gastroenterology: How to Have Stress-Free GI Pressure, Transit Measurement Reporting

The Coding Institute

You can improve your CPT?ę 2013 code 91112 claims success if you focus on whether or not the procedure was complete and concentrate on who owns the equipment for the procedure. These codes replaced the former Category III codes 0242T.

Check Payer Rules for 91112

When your gastroenterologist performs a wireless capsule test for GI pressure and transit measurement, you will report the procedure and the interpretation of results using 91112 (Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report).

Note: Many payers still consider the procedure of using a wireless capsule to measure GI pressure and transit as investigational and might not provide coverage for the procedure. Many payers also mention that this procedure needs pre-authorization, so check with payers’ coverage policies to avoid the risk of denials.

Append Suitable Modifiers for Discontinued Procedures

Your gastroenterologist may attempt a capsule study for pressure and transit measurement but may need to discontinue the procedure. One such scenario is when the patient has difficulty swallowing the capsule. In such a situation, you will have to append modifier 53 (Discontinued procedure) to 91112 to indicate the incomplete work. Another situation that warrants you to report this modifier is when the capsule gets retained in the stomach.

If your gastroenterologist repeats the procedure by placing the capsule endoscopically in the duodenum for the repeat procedure, then you need to report the procedure using 91112 and the modifier 52 (Reduced services) to the code to indicate that your gastroenterologist used the wireless capsule to measure pressure and transit in the areas beyond the stomach.

Reminder: Don’t forget to report the endoscopy that your gastroenterologist performed to place the capsule. You will have to report it with 43235 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]).

Separate Components When Appropriate

When reporting 91112 for GI transit and pressure measurements, you will have to check who owns the equipment that is being used. If your gastroenterologist owns the recording device and provides the capsule for the procedure, you will just have to report the entire procedure and the interpretations along with the report using 91112.

However, if your gastroenterologist is only providing interpretations and prepares the report for the GI transit and pressure measurements, and the hospital owns the equipment, you will have to report components of 91112 separately. In such a scenario, you will have to report the services of your gastroenterologist using 91112 with the modifier 26 (Professional component) and the hospital will report its part using 91112 with the modifier TC (Technical component).


Internal Medicine: Injection Administration Coding Edits–New?ŠBundling Policies

The Coding Institute

The latest update from the Correct Coding Initiative (CCI) brings some limited–but good–news for internal medicine physicians: approximately 30 edits involving immunization administration and evaluation and management (E/M) services now have a modifier indicator of 9, meaning that the previous bundles have been deleted and are no longer valid. The changes took place April 1, 2013, when CCI 19.1 became effective, and the deletion date is January 1, 2013, indicating the change is retroactive to the first of the year.

The explanation for the changes falls under “CPT?ę manual or CMS manual coding instructions.”?ō

Six immunization administration codes are part of the reversed edits:

– ?ť?Š90460 –?ŠImmunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered

– ?ť?Š+90461–?Š?Š…each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)

– ?ť?Š90471 –?ŠImmunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

– ?ť?Š+90472?Š1–?Š?Š…each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

– ?ť?Š90473 –?Š?ŠImmunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

– ?ť?Š+90474 –?Š?Š…each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

You can now report these administration codes in conjunction with any level of inpatient consultation without the necessity of appending a modifier to the inpatient consultation code to get both services paid, according to specialists. The affected codes are:

“Unfortunately, the other edits bundling office, outpatient, and preventive E/M services with vaccine administration codes in the absence of a valid modifier remain in place,”?ō a coding specialist notes. “That means you’ll need to continue appending a modifier, such as 25, to an affected E/M code provided at the same encounter as a vaccine administration to get paid for both services under the CCI edits.”

Exception: The one exception is 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services.). Code 99211 is bundled with a vaccine administration code, regardless of whether you include a modifier.

Recoup: The deletion date for these edits is January 1, 2013, which suggests that the change is retroactive to that date. If you had any services denied on the basis of these particular edits for dates of service between January 1 and April 1, 2013, you may want to consider appealing the denials on the basis of CCI release 19.1.


Neurology: 4 Tips for Conquering Carpal Tunnel Coding Challenges

The Coding Institute

A lack of definitive results from diagnostic tests can complicate carpal tunnel coding. Take care not to jump to a definitive diagnosis code. But this does not mean you will compromise on payment. Follow these tips to ensure you earn what you should for carpal tunnel cases.

1. Don’t Jump to a Diagnosis Too Soon

When your neurologist treats carpal tunnel syndrome (CTS), you usually report diagnosis code 354.0 (Carpal tunnel syndrome).

Note: Your neurologist may document “suspected”?ō CTS in the clinical record. If so, don’t report the definitive diagnosis code 354.0 just yet. While your neurologist is waiting for test results, you should report the patient’s symptoms in support of any services your physician provides.

Reason: ICD-9 official guidelines instruct you to use signs and symptoms codes in the office setting when your neurologist documents an uncertain diagnosis. According to ICD-9, “Do not code diagnoses documented as ‘probable,’?ō ‘suspected,’ ‘questionable,’ ‘rule out,’?ō or ‘working diagnosis,’?ō or other similar terms indicating uncertainty. Rather, code the condition(s) to the highest degree of certainty for that encounter/visit, such as symptoms, signs, abnormal test results, or other reason for the visit.”

You may find the ICD-9 guidelines on the CDC website: icd/icd9cm_addenda_guidelines.htm#guidelines

2. Check for Diagnostic Testing

To establish a diagnosis of CTS, your neurologist may perform nerve conduction studies (NCS) and/or electromyography (EMG). Each one has its own diagnostic significance.

You report 95860 or 95861 only when no NCS is performed. If both NCS & EMG are performed, then you need to look at either add-on code +95885 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; limited [List separately in addition to code for primary procedure]) or +95886 (Needle electromyography, each extremity, with related paraspinal areas, when performed, done with nerve conduction, amplitude and latency/velocity study; complete, five or more muscles studied, innervated by three or more nerves or four or more spinal levels [List separately in addition to code for primary procedure]).

Watch for the complete limb EMG. Additionally, the 95860 (Needle electromyography; 1 extremity with or without related paraspinal areas) — 95864 (Needle electromyography; 4 extremities with or without related paraspinal areas) codes, as well as the 95886 code is ONLY billed when a complete limb EMG study has been performed — testing performed on five or more muscles studied, innervated by three or more nerves or four or more spinal levels’ otherwise the code would be 95870 (Needle electromyography; limited study of muscles in 1 extremity or non- limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) if no NCS are performed.

Count nerves for NCS: You select from codes 95907 (Nerve conduction studies; 1-2 studies) — 95913 (Nerve conduction studies; 13 or more studies) depending upon the total number of separate nerves that are tested.

3. Submit Single Code Once Diagnosis Is Established

When your neurologist has established the diagnosis of CTS, focus on code 354.0. In this case, you do not report the codes for the signs or symptoms, such as numbness, tingling or finger pain. According to ICD-9, “Signs and symptoms that are integral to a disease process should not be assigned as additional codes.”

Reason: Your neurologist may be doing nerve conduction studies and/or electromyography to confirm the diagnosis of CTS. In this case, do not report the signs and symptoms as secondary diagnoses as these are integral to the primary definitive diagnosis.

4. Code for the Treatment Provided

Your neurologist may begin with noninvasive, conservative treatments in the early stages of CTS and include injections in later stages of the disease.

Initial treatment may include pain-relieving medications and a wrist brace or splint.

When pain-killers, splints, and physical therapy have failed or cannot be used for one or more reasons, your neurologist may administer injections into the carpal tunnel to perform a nerve block and relieve the symptoms. If so, submit 20526 (Injection, therapeutic [e.g., local anesthetic, corticosteroid]; carpal tunnel). Depending upon what option your payer prefers, you report either modifier 50 (Bilateral procedure) or modifiers LT (Left side) and RT (Right side) when your neurologist injects both carpal tunnels.

If the symptoms still persist, your neurologist may refer the patient for surgical treatment to relieve the pressure on the median nerve.

Note: Ensure all treatment steps are documented in the treatment plan, or payers may reject your claim based on lack of medical necessity.


Obstetrics: Troubleshoot Your Pregnant Patient Transfer Claims by Counting Visits

The Coding Institute

Prepare for coding your OB-GYN’s services up to the date of the patient’s move depending on how many antepartum visits the physician provides — here are tips for one to three and four to six visits:

1-3 Visits Mean Office E/M Codes

If your OB-GYN sees a pregnant patient for only one to three antepartum visits, how should you report it?

Answer: You need to report the appropriate E/M codes for payment. You won’t have a set E/M code for the patient’s first visit. Your patient could be new to the practice, or the first visit may meet the criteria for a level-five established visit. Therefore you should look to the entire code series (99201-99205 for new patients, 99211-99215 for established patients) as possible options.

Second and third visits: Now your coding options are more limited.

When Medicare and ACOG were developing the relative value units for antepartum care, the follow-up visit was estimated to be a 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...), so this code is your best bet for each of these visits in the absence of documented problems.

Note: In some rare circumstances, such as when the patient has absolutely no problems during the visit, however, the documentation might support reporting only 99212 (Office or other outpatient visit for the evaluation and management of an established patient … Physicians typically spend 10 minutes face-to-face with the patient and/or family) for each visit.

If the patient’s pregnancy is without complication, your diagnosis would be either V22.0 (Supervision of normal first pregnancy) or V22.1 (Supervision of other normal pregnancy).

Watch out: Because you do not have a specific antepartum code for one to three visits and have to report E/M codes, payers sometimes will deny these claims and tell you to “include in the global.”?ō You are forced to appeal these decisions. Explain to the payer that you cannot report a global code because you are no longer the patient’s OB care provider.

4-6 Visits Mean Antepartum Code

Your ob-gyn sees a pregnant patient for four to six antepartum visits. How should you report this?

Answer: Four to six visits means you?ů‘ťľ‘šůll be flipping through your book to the maternity care and delivery section — particularly the antepartum codes. You should report 59425 (Antepartum care only; 4-6 visits), which represents the total services rendered by your ob-gyn. This means that you’ll report only one unit of this code.


Opthalmology: Focus Your Cataract Coding With This Tip

The Coding Institute

With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error — with over $800 at stake for complex cataract procedures in 2013.

Use this tricky scenario as a guide:

Document Necessity for Planned Vitrectomy

Scenario: During the course of a cataract removal, the vitreous collapses and the ophthalmologist finds it necessary to perform a vitrectomy.

Question: Can you code separately for the vitrectomy?

Answer: The answer depends on whether the vitreous collapse was an iatrogenic (inadvertently introduced) complication. Ophthalmologists often have to perform a vitrectomy during cataract surgery due to vitreous collapse in the course of removing a dense, senile cataract. In these cases, Medicare considers the vitrectomy a component of the cataract surgery, and thus not separately payable.

The National Correct Coding Initiative bundles vitrectomy codes 67005 (Removal of vitreous, anterior approach [open sky technique or limbal incision]; partial removal) and 67010 (…subtotal removal with mechanical vitrectomy) into cataract surgery ?Šcodes 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex …) and 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).

Rationale: When procedures are performed together that are basically the same, or performed on the same site but are qualified by an increased level of complexity, the less extensive procedure is included in the more extensive procedure. The column 1 code generally represents the comprehensive service, and the column 2 code is the component that is part of the more extensive column 1 procedure.

Exception: If a prolapsed vitreous exists and is known in advance — and documented in the patient medical record — it is not considered a complication of the cataract surgery. Therefore, the physician who plans to perform a vitrectomy during the same operative session of cataract surgery could code separately for the vitrectomy using modifier 59 (Distinct procedural service): 67005-59 or 67010-59.

Key: Use 379.26 (Vitreous prolapse) for the vitrectomy and the appropriate cataract diagnosis (366.x, Cataract) for the cataract removal.

Be prepared to provide documentation in case you receive denials when using the cataract and vitrectomy codes together, despite using modifier 59. Payers are aware of the potential for abuse of 59 and may want you to go through the review process to prove you’ve met the definition of “distinct procedural service.”?ō

Provide the chart notes to show that you knew about the vitreous collapse in advance and that you made plans to repair it prior to the surgical session of another service. Also, you should provide the operative report with clear documentation showing that there was another condition, besides the cataract surgery, that made the vitrectomy medically necessary.

Posted on July 15, 2013 by · Leave a Comment
Filed under: Medical Billing, News, Tips and Tricks  

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New 1500 Claim Form Approved to Accommodate ICD-9 or ICD-10 Diagnosis Codes
Version 02/12 1500 Health Insurance Claim Form (1500 Claim Form), which accommodates reporting needs for ICD-10, was approved, the National Uniform Claim Committee (NUCC ) announced on June 17, 2013. The Office of Management and Budget (OMB) has approved the 1500 Claim Form under OMB Number 0938-1197.

During its work, the NUCC was made aware by the healthcare industry of two priorities that were included in the revisions to the 1500 Claim Form. The first was the addition of an indicator in Item Number 21 to identify the version of the diagnosis code set being reported; i.e., ICD-9 or ICD-10.

The need to identify which version of the code set is being reported will be important during the implementation period of ICD-10.

The second priority was to expand the number of diagnosis codes that can be reported in Item Number 21, which was increased from 4 to 12. Additional revisions will improve the accuracy of the data reported, such as being able to identify the role of the provider reported in Item Number 17 and the specific dates reported in Item Number 14.

Read More:


For Billing Purposes, When Should a New Provider Start Seeing Patients? Review 3 FAQs to Avoid Giving Away Free Services
The Coding Institute
When a new physician joins your practice, if you don’t think about getting the new provider’s credentialing info to your payers before he starts seeing patients, you will actually lose money, upset patients, and possible face fraud charges before you see any benefits.

Review these three frequently asked questions to make sure you are equipped to face the challenge of how to bill for the provider’s services to both new and established patients who visit him at your practice.

1. ?ŠCan We Bill Retroactively?
When you can bill for a new physician’s services depends on when you’re able to get him/her credentialed. You’ll also need to know the differences between the payers you bill, because they do not all follow the same policies.

For Medicare, you’re allowed to bill 30 days retroactively. Regardless of when the provider starts with your practice, you’ll only be able to retroactively bill Medicare for services your physician rendered up to 30 days prior to the date he received his Medicare credentialing status.

Note: In the past you had a full 27-month window during which you could retroactively bill. That changed in 2009.

2. ?ŠCan We Just Use Another Provider’s NPI?
In a word, “No.” While it may be tempting, you should not use another credentialed doctor’s national provider identifier (NPI) on the new doctor’s claims to get paid for services the new physician performs before being credentialed. Doing this is considered fraud.

Either avoid having the new physician see patients until the Medicare credentials come through, or have the physician see only patients who are self-pay or who have insurance that allows you to bill before credentialing.

Question: You can just report the new doctor’s service under an existing physician’s ID number and append the locum tenens modifier to it, right?

Answer: No. Locum tenens is designed to represent services performed “in the absence of the regular physician,”?ō according to chapter 1 of the Medicare Claims Processing Manual. Practices that simply report the new physician’s service as if it was performed by a locum tenens doctor, are violating the original intent of the locum tenens rules.

3. ?ŠWhat is the Best Way to Ensure We Get Paid?
Allow your office more time when trying to credential a new physician.

The process can take 90 days or even longer, according to Medicare. Experts recommend that you initiate this process as far in advance of your new physician’s starting date as you can (once you have all the necessary information such as the state license and DEA number); two months ahead of time, if not more. Experts advise that with the advent of PECOS, things should move quicker, but say that some of the commercial payers could take as much as six months.

If you act early, you’ll have the necessary credentials in place when the physician starts seeing patients and you won’t have to hassle with delayed payments.


Medicare to Boost Physician Payments for Complex Care Management

CMS issued a proposed rule on July 8 that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) at the start of 2014. Currently, Medicare only pays for primary care management services as part of a face-to-face visit; under the proposed rule, CMS would make a separate payment to physicians for managing select Medicare patients’ care needs beginning in 2015. CMS will accept comments on the new rule until Sept. 6, then will generate the final rule by Nov. 1.

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Monitor Revenue to Strengthen Bottom Line

In a competitive healthcare marketplace like Dallas-Ft. Worth, a physician practice must tightly manage its revenue cycle. Texas Health Physicians Group (THPG) is doing that by tracking five key financial metrics.Sam Civello, vice president at THPG, told attendees at the 2013 HFMA ANI conference that THPG follows five metrics it considers critical to physician revenue performance. They are:

–?Š?ŠClaim entry dates?Š– Two days or less from the date of service.
–?Š?ŠUn-reconciled visits?Š– Maintain at 0.5 percent or less.
–?Š?ŠPre-bill rejection rates?Š– Maintain at 4 percent or less.
–?Š?ŠFirst-pass denial rates?Š– Keep them at less than 10 percent.
–?Š?ŠPass-through rates?Š– Keep them below 3 percent.

Read more:

Posted on July 12, 2013 by · Leave a Comment
Filed under: ICD 10, Medical Billing, News, Resources  

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ICD-10 continues to be a hot topic in healthcare, with many practices not yet having started on their implementation plans. Here are some of the top articles this month:

Top Ten ICD-10 Readiness Questions to Ask Your Vendors
One of the biggest challenges facing the industry ahead of ICD-10 is coordination among tens or hundreds of business partners. The questions you should be asking include:

1. Who is my dedicated contact person?

2. When will your ICD-10 compliant system be ready?

3. Are there any additional costs involved for upgrades or ongoing maintenance?

4. Are there new hardware requirements on my end

5. Will there be new things to learn within the software interface?

6. What customer support and training will be provided?

7. What is the basis of your crosswalk or mapping strategy?

8. Will your product support dual coding?

9. What is your external testing strategy?

10. Do you have a contingency plan if you’re not ready by October 2014?

For the full explanations of each point, see the complete article at:


5 Lessons from 5010 the Healthcare Industry Can Apply to ICD-10
The?ŠHealthcare Billing and Management Association?Štestified before the National Committee on Vital and Health Statistics’ Subcommittee on Standards in Washington, D.C., on mistakes the healthcare industry can avoid during the ICD-10 coding transition.

Here are five lessons, according to HBMA, that the healthcare industry should heed during the ICD-10 switch:

1. Complete end-to-end testing with all payers to ensure readiness.
2. CMS must establish good benchmarks for readiness, not to be ignored by industry members.
3. Physicians and staff cannot rely on a vendor or software coding tool for accurate documentation and coding. Rather, appropriate education is the only way to be prepared.
4. Payer policies published by Oct. 1 must allow time for education, training and data analysis.
5. Payers only accepting 4010 claims must be 5010 compliant by Jan. 1, 2014, to be ICD-10-CM ready.


Most Practices Not Ready for ICD-10 Implementation
Most practices are not ready to meet the October 1, 2013 deadline for compliance with International Classification of Diseases, Tenth Revision (ICD-10), according to a report published by the Medical Group Management Association (MGMA).

A survey by MGMA revealed that only 4.8% of practices reported they had made significant progress toward overall readiness for ICD-10 implementation, and 55.4% reported they had not yet started on the process. The survey involved about 55,000 physicians from 1,200 practices.

More than 70% of practices surveyed reported that they had not heard from the major health plans regarding the ability to test claims, and 59.7% reported the same of claims clearinghouses.

Overall costs (81.1%), changes to clinical documentation (88%), and loss of clinician and coding staff productivity (87.5%) after implementation were among top clinician concerns. Expected difficulties included ability to document patient encounters and ability to select the appropriate diagnosis code.

Just 32.% of respondents reported their cost to upgrade or replace their practice management system software will be covered by their vendor. Only 37% said their vendor will cover the cost to upgrade/replace their EHR.

For organizations that must cover the costs themselves, the average cost for a 10-physician practice to upgrade or replace their practice management system and EHR software to accommodate ICD-10 is $201,690.

Read the full article at:

See articles on ICD-10 on our blog at

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Yesterday we posted the first part of our Denial Management Quiz so that you could see how well you scored on your knowledge of techniques for improving your denial rates. Now let‘«÷s move on to Part 2 with some more sophisticated techniques. Ready? (Missed Part 1? Read it here.)

1. Now that we‘«÷ve established that you should track denials, what exactly should you track?

A.?Š Total claims denied for your practice; Total claims filed to a payer; Number and dollar value (charge) of denied line items;

B.?Š Total claims filed to a payer; Number and dollar value (charge) of denied line items; Calculate percentage denied (B divided by A)

C.?Š B above, plus calculate these percentages for your entire medical practice and also by payer, reason, provider, specialty, and location (if you have more than one office)

D. A, B & C


2. When you‘«÷re notified that a claim has been denied, what is your next action?

A. Refile the claim as is; the insurer clearly didn‘«÷t review it

B. Write it off and move on to other claims; if the claim could have been approved, it would have been the first time

C. Investigate; approximately 75% of denials can be resolved without an appeal

D. Appeal; the insurer may need additional information to approve the claim

E. C and D


3. In order to prevent future denials, you should:

A. Fire the person responsible immediately

B. Return denials to their origin (for example, registration errors to front office)

C. Establish a feedback loop with providers by listing top denials at provider meetings; attach EOB examples

D. Educate billing staff on denials, but don‘«÷t bother the providers with the details

E. B and C


4. Your practice should appeal:

A. Every claim, every time

B. Establish a minimum amount for claims to be appealed across the board

C. Different types of denials at different amounts. Establish a protocol for different types of denials and different amounts



1. C; To correctly track the number of claims that are denied for your practice, you‘«÷ll want to measure the following:

i)?Š Total claims filed to a payer (number and total charge amount)

ii)?Š Number and dollar value (charge) of denied line items

iii)?Š Calculate percentage denied (B divided by A)

iv)?Š And calculate these percentages for your entire medical practice and also by payer, reason, provider, specialty, and location (if you have more than one office)


2. E; When a claim is denied, you want to investigate to see if the denial can be resolved without an appeal, but if not, then APPEAL! 75% of appeals result in denied claims being overturned and paid.


3. E; In order to prevent future denials, you should return denials to their origin and establish a feedback loop with providers.


4. C; Your practice should appeal different types of denials at different amounts. Establish a protocol for different types of?Šdenials and different amounts, and test the results. There are ‘«£soft‘«ō denials that can be easily corrected, and ‘«£hard‘«ō denials that require more effort. A $20 ‘«£hard‘«ō denial may not be worth the $25-30 it costs most practices to appeal.


How Have You Scored in Part 2?

4 Correct: You‘«÷re a Denial Champ!

3 Correct: You‘«÷re doing well, but take note of the explanations above to improve your score.

2 Correct: Keep learning!

1 Correct: Hmm‘«™you may need some help with your medical billing. Consider hiring a medical billing service like, which allocates over 50% of its billing costs to the successful collection of the last 20-30% of charges that typically do not get paid on first submission. These are the claims your staff probably doesn‘«÷t have either the time or expertise to collect on‘«Ųbut we do, and we do it every day.

On average, our physician clients get paid faster than 75% of multi-specialty group practices nationwide as surveyed by the Medical Group Management Association and Healthcare Billing Management Association for Days Revenue in AR.

Contact us today to find out how we can help improve your medical billing results and free your staff to focus on patient care.

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