Let’s talk about global periods. Every surgical Current Procedural Terminology (CPT) code includes a surgical package, aka global period. This includes anything from a laceration repair to earwax removal, from fracture care to a transplant surgery. This surgical package per the CPT guidelines includes the following: • An Evaluation and Management (E/M) service (either the day of the procedure or the day before the procedure) which includes taking a history and performing an exam … • Local anesthesia … • Immediate postoperative care … • Writing any orders for the patient … • Evaluating…

Anthem, America’s second largest health insurance provider, has changed its emergency room policy. And while those words often aren’t so good to hear, you may be surprised by the effect they will have on your urgent care business. Those with an Anthem plan won’t have their visits to the ER covered, now, if they visit for a non-emergency reason. This is to keep from congesting the ER waiting room, and to keep the company from having to cover the expenses of such an expensive visit. This means more business for your urgent care clinic! Be anticipating this change as it is…

What's the difference between simple, intermediate, and complex repairs? What do you really need to document? Are you missing out on reimbursement? These procedures can sometimes be confusing. A complicated laceration does not necessarily mean that the repair is intermediate or complex. There are a few questions to ask to determine what type of repair needs to be done. How deep is the laceration? Is it contaminated with foreign material? Is debridement necessary? See the following descriptions of the different coding options: Simple Repair - One layer skin closure, or electrocautizeration…

The importance of a healthy bottom line is fundamental to the survival of any health care provider, whether it is a 300-bed hospital, a specialized surgical center, or an emergency department of a community based urgent care center. The continuing existence of any health care provider is becoming more and more dependent on the success (or lack of success) of the relationships these entities have with a Managed Care Organizations (MCO), and the managed care agreements that connect a health care provider and the MCO. These relationships will often start off with enthusiasm and a drive for a…

Creating new revenue sources to attract new patients and to better serve existing patients is critical for the growth of any company. As the saying goes: If you are not growing, you are dying. So grow, baby, grow! Dr. Reynolds points out in his post “3 Keys to Revenue Success,” that there are only three ways to increase revenue: • Increase the number of customers, • Increase the price per customer, and … • Increase the number of times a customer returns. There is another way to achieve increased revenue, though: contracting with a vendor to provide services. For example, you could…

Whether you are an experienced or a new health care provider, it is likely that you have questioned the what, when, why and how of the credentialing process. The truth of the matter is….it ain’t easy… … Receiving and completing credentialing documents can be overwhelming, to say the least. The basic required credentialing documents may include, but are not limited to: Payor applications … State standardized credentialing applications … State licensing applications … CAQH enrollment forms … Malpractice Coverage … Medicare applications … Medicaid applications … Payor…

As a health care provider, it is likely that you have had to respond to questions in credentialing applications, a license renewal or a certification regarding your background, history or to information that doesn’t really seem applicable to your ability to provide services to your patients…quess what….it is applicable!! Most, if not all, applications related to the provision of health care services, typically include a series of questions that require a response for the application to be processed. These questions are often referred to as “Attestation&rdquo…

One of the most important medical billing tips for getting faster reimbursement is better documentation. A few extra minutes can save you time and money and help you get paid faster. It’s important you understand why. The average AR days for a claim to be paid after it is sent out is between 25-33 days. Are your AR days within this range? If not, one of the first steps you can take at the clinic level is completing your medical records. Documenting the history, exam and medical decision making is a must but there are a lot of other things that can cause a medical record to be…

It’s ok to copy and paste, right? Maybe. The answer depends on what you plan to copy and paste. Most EMRs have a function where past information will auto-populate into the current medical record. This can be a useful timesaver, especially in the history section. However, you must be aware of the risks associated with this action. One place to watch is the current medications list. Some EMRs will automatically carry over every medication the patient has previously reported or prescribed by your clinic. Sometimes a patient will have two or three pages of medications listed. It will show…

Your billing company is a crucial component to your practice's success. Learning and understanding the billing process and what your biller does daily, will help contribute to the everyday operations of your business. What Does Your Medical Biller (actually) Do? Your biller's job is to use provider documentation to produce and submit claims to insurance companies. Your biller will then work directly with the insurance companies, healthcare providers, and patients to get claims processed and paid. They also review and appeal unpaid and denied claims. Your billing team will verify…