Tagged with Physicians

Want to Confirm a High-Level ED Code? Examine the Note

Marie Franklin, MBA. CPC, National Director of Coding, Education, and Audit, AdvantEdge Healthcare Solutions, informs readers in the tci Newsletters ED and Coding Reimbursement Alerts E/M, Want to Confirm a High-Level ED Code? Examine the Note provides the information you need to avoid upcoding your ED services.  To read the considerations for ED coding to…

“Flip’n Surgeons” –Calculating the Utilization Rate of Surgeons Who Flip Operating Rooms

By Joe Laden, Vice President Client Management                 Surgeons who “flip” ORs have two simultaneous operating rooms allocated to them and, therefore, have two anesthesiologists or two anesthesia care teams in these ORs.   For a very busy surgeon, this is usually good for the surgeon, hospital, and the anesthesiology group.   However,  some surgeons would like to…

To Hold, or Not to Hold – That is the Question. Delaying Claim Filing to Avoid Deductibles.

By Joe Laden, Vice President Client Management Effective collection of patient insurance deductibles is an increasing problem for anesthesiologists.  Anesthesia claims are usually ready to file a few days after the date of service and can typically reach insurers before claims by the hospital and the surgeon. If the anesthesia claim hits the payer first…

Your Anesthesia Net Collection Ratio – Can it be 100%?

 By Joe Laden, Vice President of Client Management The short answer:  “Yes, but probably not.” Typically, the Net Collection Ratio (NCR) is calculated as Payments / (Charges – Contractual Adjustments). If contracted payers paid all your charges with nothing left to patients or secondary payers, the Net Collection ratio would be 100%, assuming that all…

2021 Proposed Changes for Evaluation and Management Services

By Marie Franklin, MBA, National  Director of Coding, Education, and Audit The proposed new rules for 2021 will focus on medical decision-making or time as the determining factor when selecting the appropriate level for service rendered for all physicians for evaluation and management. Currently, Medicare has not made Medical Decision Making (MDM) as one of…

Infographic – AdvantEdge Healthcare Solutions – Radiology

AdvantEdge Healthcare Solutions is one of the nation’s best radiology billing, coding, and revenue cycle management vendors for radiology practices across the country. To learn how AdvantEdge can be your  billing and coding vendor, call us at 877-501-1611 or email us info@ahsrcm.com    

The Secret Ace up Your Sleeve – Using Your Anesthesia Billing Vendor for Stipend Negotiations

By Joe Laden, Vice President of Client Management Many anesthesiology practices rely on financial support from their hospital. This is commonly due to poor payer mix, underutilization of operating rooms and/or intensive in-house call requirements. Requests for hospital financial support must be backed up with solid information showing that anesthesia personnel costs based on hospital…

CMS Targeted Probe and Educate Audit Program

By Jeanne A. Gilreath, CHBME, Senior Vice President and Chief Compliance Officer One of the many programs CMS has implemented to help providers identify billing issues is the Targeted Probe and Educate (TPE) audit program.   It is designed to identify providers with high denial rates or unusual billing practices according to CMS.  If a provider is…

Anesthesia RCM Specialty Challenges

By Joe Laden, Vice President Client Management Anesthesia billing and coding is an array of unique and complex specialty requirements not found in other medical specialties.  Though many billing and coding companies claim experience and expertise in anesthesia billing, the truth, when compared against actual performance, tells a different story. Given the unique aspects of…

Infographic – AdvantEdge Healthcare Solutions – Corporate

AdvantEdge Healthcare Solutions is a national top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for specialty medical group practices since 1967.   If you have questions about how AdvantEdge can improve your billing and coding so that you are collecting every dollar that you’re legally and ethically entitled, please call…

Infographic – Advantage Healthcare Solutions – Anesthesia Services

AdvantEdge Healthcare Solutions is a national top 10 medical billing company that provides billing, coding, and revenue cycle management solutions for anesthesia practices since 1989.   If you have questions about how AdvantEdge can improve your anesthesia billing and coding so that you are collecting every dollar that you’re legally and ethically entitled, please call us…

Surprise Billing Legislation is Gaining Traction with an Unknown Future for Physicians

By David Nicholson, Executive Vice President Surprise medical bills occur when an insured patient unintentionally receives care from an out-of-network provider. And, according to a 2018 survey conducted by the University of Chicago, more than half of Americans (57%) have received at least one unexpected medical bill that they believed was covered by insurance. The topic of…

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