Medical Billing Guide Medical Coding Guide

2024 Healthcare Trends: Navigating the Future of Healthcare

Healthcare trends are constantly evolving, shaping the future of the industry and impacting patient care delivery. As we look towards 2024, it’s essential to understand the key trends that will drive transformation in health systems, the role of payers, challenges in primary care practices, embracing technology advancements, and anticipating shifts in the healthcare landscape.

Understanding the Impact of 2024 Healthcare Trends

Exploring the transformation in health systems involves analyzing how healthcare organizations will need to adapt to innovative models larger than commercial. These changes are crucial for improving patient care and enhancing healthcare services.

When analyzing the role of payers in the healthcare landscape, it’s important to consider the impact of value-based care on patient care delivery. Payers play a significant role in shaping how healthcare services are provided and reimbursed, influencing the overall quality of care.

Challenges and opportunities in primary care practices highlight the need for healthcare providers to focus on preventive care and remote patient monitoring. These practices can improve patient outcomes and efficiency in care delivery.

Embracing Technology Trends in Healthcare

The rise of artificial intelligence in healthcare is revolutionizing patient care by enabling predictive analytics and personalized treatments. Integrating health plans with digital health solutions creates a more seamless healthcare experience for patients and providers.

Consumer health trends are shaping the future of healthcare by emphasizing patient engagement and personalized care. As patients become more involved in their healthcare decisions, healthcare organizations must adapt to meet these evolving needs.

Anticipating Shifts in the Healthcare Industry

Adapting to innovative healthcare models larger than commercial requires healthcare organizations to partner with industry leaders like McKinsey to navigate these changes successfully. Generative AI applications in healthcare provider settings enhance the efficiency and effectiveness of care delivery.

Value-based care is transforming patient care delivery by focusing on outcomes rather than services rendered. Understanding the impact of these shifts in the healthcare industry is essential for healthcare organizations to thrive in 2024.

Navigating Healthcare Challenges in 2024

Addressing staff shortages amidst the COVID-19 pandemic remains a critical challenge for healthcare organizations. Utilizing artificial intelligence to improve revenue cycle management can streamline financial processes and minimize revenue loss.

The role of remote patient monitoring in clinician efficiency is vital for optimizing patient care and resource allocation. By embracing technology solutions, healthcare providers can enhance the quality and accessibility of care.

Future Outlook for Health Technology in 2024

Enhancing Medicaid services through digital health innovations is crucial for improving access to care for underserved populations. Optimizing patient engagement with remote healthcare solutions ensures that patients remain connected and informed about their health.

Ensuring data security and compliance in the era of health technology is paramount for protecting patient privacy and maintaining trust in healthcare services. By embracing the latest technological advancements, healthcare organizations can navigate the future of healthcare with confidence.

For more insights into the future of healthcare, contact us today!

Medical Billing Guide Medical Coding Guide

The Impact of Telehealth on Medical Billing and Coding

How does telehealth affect medical coding and billing?

Telehealth services have revolutionized the healthcare industry by providing patients with access to healthcare services remotely. This trend has had a significant impact on medical coding and billing processes. In terms of coding, professionals must accurately assign telehealth codes based on the services provided during a virtual visit. This requires a clear understanding of telehealth coding guidelines to ensure proper documentation and billing.

When it comes to billing, telehealth services require specific billing procedures to ensure proper reimbursement. Understanding the nuances of telehealth billing is crucial to avoid billing errors and ensure timely payments. Effective management of the revenue cycle in telehealth settings is essential for streamlining the billing and coding processes.

Telehealth has streamlined the way medical services are provided and billed for. In the realm of coding, professionals must navigate through telehealth-specific codes such as HCPCS codes. These codes help identify the services provided via telehealth, allowing for accurate billing. On the other hand, effective billing in telehealth requires adherence to specific reimbursement guidelines to ensure that healthcare providers are compensated for the services rendered.

Revenue cycle management in telehealth settings involves overseeing the entire process from scheduling appointments to receiving payments. Professionals must ensure that telehealth services are billed correctly to prevent revenue cycle disruptions. By staying up-to-date with the latest coding and billing practices related to telehealth, healthcare facilities can optimize their revenue cycle and improve financial outcomes.

What are the reimbursement challenges in telehealth services?

Telehealth services face various reimbursement challenges, especially concerning medicare coverage. Providers need to navigate through complex medicare telehealth billing regulations to ensure compliance and maximize reimbursement. Implementing best practices in telehealth billing can help address these challenges and optimize reimbursement.

Understanding the different protocols for telehealth reimbursement is crucial for healthcare providers to capture the full value of the services provided. It’s essential to stay informed about the latest reimbursement policies and adhere to best practices to minimize claim denials and delays in payments.

Reimbursement challenges in telehealth services require healthcare providers to navigate through a complex landscape of regulations and policies. Medicare coverage for telehealth services is continually evolving, and staying updated on the latest changes is crucial for ensuring proper reimbursement. Providers need to implement best practices in telehealth billing to optimize revenue and address reimbursement challenges effectively.

Telehealth billing processes require meticulous attention to detail to avoid claim denials and ensure prompt reimbursements. That’s why PractiSynergy is here; we’ll pay attention to those little details in your medical billing and coding so you can focus on your practice.

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Innovations in Skin Grafts & What it Means for Your Practice

What is Skin Grafting and Its Evolution?

Skin grafting involves the transplantation of healthy skin from one part of the body to another to treat skin wounds or large defects. Over time, the technique of skin grafting has evolved significantly, from ancient practices to modern innovations like artificial skin and autologous skin grafts. It plays a crucial role in the treatment of severe burns and skin loss, particularly benefiting burn patients with extensive damage.

Skin grafting techniques have advanced from simple procedures to sophisticated methods, enhancing outcomes for patients. Understanding the evolution of skin grafting is essential for healthcare practitioners who perform these procedures.

Advancements in skin grafting, including the use of artificial skin, have revolutionized the way skin wounds are treated, offering new possibilities for patients with extensive skin damage, such as burn victims. As skin grafting continues to progress, its applications in medical practice expand, benefitting both patients and healthcare providers.

Understanding the Basics of Skin Grafting

Skin grafting is a surgical procedure that involves transferring skin from a healthy donor site to cover a wound or defect, crucial for burn wound treatment using either a split-thickness skin graft or a full-thickness skin graft. It aims to promote healing and improve the function of damaged skin. The donor site can vary depending on the type of skin graft used, such as a split-thickness skin graft or a full-thickness skin graft.

A split-thickness skin graft involves removing the top layers of skin, known as split-thickness skin, while a full-thickness skin graft includes the entire thickness of the skin. Each type has specific indications and applications in different clinical scenarios, such as burn injuries or reconstructive surgeries, with split-thickness skin grafts often used in the treatment of burn wounds.

Donor sites are carefully selected to minimize donor site morbidity and ensure successful grafting, often involving the use of donor skin for better outcomes. The choice of donor site depends on factors like skin quality, location, and the size of the graft needed.

Evolution of Skin Grafting Techniques

The historical development of skin grafting dates back centuries, with early techniques using simple methods to cover wounds. Over time, advancements in surgical and medical knowledge, including the development of artificial skin, have led to the refinement of skin grafting procedures.

From autologous split-thickness skin grafts to modern skin substitutes, the evolution of skin grafting techniques has significantly improved patient outcomes. Innovations like mesh grafts and pinch grafts have expanded treatment options for various skin conditions.

Understanding the historical roots of skin grafting provides valuable insights into the origins of modern practices and the continuous development of skin grafting techniques to meet the evolving needs of patients.

What it Means Your Medical Billing and Coding

While traditional autologous skin grafting is still considered the gold standard, new methods of skin harvesting and skin grafting techniques have expanded the possibilities for treatment. The use of meshed split-thickness skin grafts and other innovative approaches have allowed for the efficient coverage of large areas of damaged skin with a limited amount of donor skin. These advances in skin regeneration and skin graft donor site utilization have greatly improved the function of the skin and subcutaneous tissue in the treatment of skin injuries.

Medical billing and coding professionals like PraciSynergy must stay up-to-date on the latest skin grafts and skin replacement techniques to accurately code for these procedures. With the increasing use of meshed skin grafts and other innovative approaches, it is important to document the specific methods of skin harvesting and skin grafting used in each case to ensure proper reimbursement. As technology continues to advance in the field of skin grafts, billing, and coding practices will need to adapt to accurately reflect the complexity and cost of these procedures.

CPT Codes Medical Billing Guide Medical Coding Guide Vaccines

Understanding CPT Codes for COVID-19 Vaccines

What are CPT Codes?

Current Procedural Terminology (CPT) codes are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services. They are used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer.

CPT Codes for COVID-19 Vaccines

The American Medical Association (AMA) has approved unique CPT codes for COVID-19 immunizations. These codes help to better track, report, and analyze data for the planning and allocation of vaccines.

As of August 14, 2023, the CPT Editorial Panel approved the addition of new product codes 91318-91322 to identify monovalent vaccine product for immunization against COVID-191. These codes are used for the Pfizer and Moderna vaccines. The existing Novavax Product Code 91304 was retained for the currently authorized vaccine product available for use in the U.S.

Here are the new CPT codes for Pfizer and Moderna’s vaccines, as well as a new administration code that applies to all COVID vaccines:

How PractiSynergy Can Help

At PractiSynergy, we understand the complexities of medical billing and coding. Our team of experts is here to help you navigate the intricacies of CPT codes for COVID-19 vaccines. We provide expert medical billing, credentialing, and medical coding to a diverse range of medical practices, providers, and facilities.

Don’t let the complexities of medical billing and coding slow down your practice. Contact PractiSynergy today and let us help you streamline your billing process, reduce administrative burdens, and improve your practice’s efficiency and profitability. Let us handle the complexities of medical billing so you can focus on what you do best – providing excellent care to your patients.


Medical Billing Guide Medical Coding Guide

Demystifying Medical Billing and Coding Part 2

In our last blog, we started the process of demystifying the complicated world of medical billing and coding. We’ve still got a bit more to go to fully provide a comprehensive guide to this field. But don’t worry–if this world seems to be a little too tough to understand on top of everything else going on in your life and in your practice, PractiSynergy is here for you. Instead of struggling to learn the process of medical billing and coding, we’re happy to handle it for you! Let’s dive in. 

The Significance of Coding Systems

There are three major coding systems used in the healthcare industry:

  • The International Classification of Diseases, 10th Edition (ICD-10) is used to classify diagnoses and illnesses.
  • The Current Procedural Terminology (CPT) is used to describe medical, surgical, and diagnostic services.
  • The Healthcare Common Procedure Coding System (HCPCS) is used to code services not covered by CPT, such as durable medical equipment and drugs.

Medical coding relies on standardized coding systems to ensure consistency and clarity in communication. The International Classification of Diseases, 10th Edition (ICD-10) categorizes diagnoses and illnesses, while Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic services. Healthcare Common Procedure Coding System (HCPCS) codes cover services not included in CPT, such as medical equipment and drugs.

The Coding Process: Ensuring Accuracy

The coding process involves meticulous attention to detail. Coders collaborate closely with healthcare providers to gather accurate information about procedures and diagnoses. This information is then translated into the appropriate codes, which are submitted for billing. Accuracy in coding is paramount, as it directly influences the reimbursement process and prevents claim denials or underpayments.

Collaboration for Accurate Coding

Effective communication between medical coders and healthcare providers is essential for accurate coding. Coders seek clarifications when needed to ensure that codes accurately reflect the provided healthcare services. This collaboration guarantees that claims are submitted with precision, enhancing the chances of proper reimbursement.

The Medical Billing Process: Submission to Reimbursement

The medical billing process extends from claim submission to reimbursement. Medical billers play a crucial role in this journey by meticulously preparing and submitting claims to insurance companies. This process demands an in-depth understanding of insurance policies, proper documentation, and compliance with regulatory standards.

Challenges and Solutions in Billing and Coding

The realm of medical billing and coding isn’t without its challenges. Claim denials, coding errors, and communication breakdowns can hinder efficient revenue management. However, solutions exist. Thorough documentation, continuous training, and open communication between providers, coders, and billers can mitigate these challenges and optimize the revenue cycle.

Regulatory Compliance: Upholding Industry Standards

Adhering to industry regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the Stark Law is paramount. Non-compliance can lead to legal repercussions and disruptions in the billing and coding process. Ensuring patient data privacy and adhering to legal standards are critical components of the revenue cycle.

The Impact of Technology

Technological advancements have revolutionized medical billing and coding. Electronic Health Records (EHR) store patient information digitally, enhancing accuracy in documentation and coding. Automated coding tools assist coders in assigning appropriate codes efficiently. However, maintaining a balance between technology and human expertise is crucial to prevent errors and ensure accurate reimbursement.

The Role of AI and Machine Learning

Artificial Intelligence (AI) and Machine Learning (ML) are reshaping the landscape of medical billing and coding. These technologies can analyze vast amounts of clinical data to assist coders in selecting the most accurate codes, reducing errors and enhancing reimbursement optimization. Additionally, predictive analytics offer insights into revenue management and potential risks, enabling proactive measures.

Preparing for the Future: Trends in Medical Billing and Coding

As the healthcare industry evolves, so does the landscape of medical billing and coding. Artificial intelligence, machine learning, and telehealth are emerging as significant influencers. AI and ML technologies promise improved accuracy in coding, while telehealth’s rise necessitates adaptation to coding practices for new service delivery models.

While technology continues to make headway in many different fields, it can never replace the human touch. At PractiSynergy, we know how to utilize these technological advances; but we also know the right questions to ask, the correct steps to take, and of course, to make relationships and connect with other people. 

As telehealth reshapes healthcare delivery, adapting coding practices becomes paramount for precise reimbursement within this evolving service. Amid these dynamic changes, the mastery of these essential processes remains pivotal for sustainable revenue management and top-tier patient care. For comprehensive medical billing and coding services that prioritize seamless payments, consider exploring PractiSynergy—a partner empowering practices to concentrate on quality care while we handle the intricacies of payments…so you don’t have to. 

Contact us today to learn more!

Medical Billing Guide Medical Coding Guide

Demystifying Medical Billing and Coding Part 1

In the intricate world of healthcare, the seamless functioning of medical billing and coding is essential for both providers and patients alike. This crucial process involves translating complex medical procedures and diagnoses into standardized codes, ensuring accurate revenue management and reimbursement for healthcare services. In this comprehensive guide, we’ll delve into the fundamental aspects of medical billing and coding, its significance, key coding systems, processes, challenges, and future trends–and how PractiSynergy fits into it all. 

What is Medical Billing and Coding & Why is it Important for Providers?

Medical billing and coding are integral parts of the healthcare revenue cycle. Medical billing and coding is the process of translating medical diagnoses and procedures into codes used in medical records and claims submitted to payers for reimbursement. It is a complex and specialized field that requires a deep understanding of medical terminology, anatomy, and disease processes. This symbiotic process ensures healthcare providers receive proper compensation for their services and contributes to efficient revenue management within the healthcare industry. By properly coding and submitting claims, providers can secure timely reimbursement, which is vital for sustaining operations, offering quality care, and investing in advanced medical technologies. This process also helps prevent revenue leakage due to errors or improper documentation.

 It sounds pretty complicated, right? On top of running an effectively functioning practice, managing staff, and of course, treating your patients, correctly getting your billing and coding done can seem like quite the feat. That’s why PractiSynergy exists–so that you can focus on what’s most important, instead of having your hands full with your payments. 

Medical Billing vs. Medical Coding

Medical billing and coding are often used interchangeably, but they represent distinct stages in the revenue cycle. Medical coders are responsible for translating complex medical information into standardized codes, while medical billers focus on submitting these coded claims to insurance companies for reimbursement. Both roles require a keen understanding of medical terminology, anatomy, and coding systems. As a medical provider, learning coding systems on top of the rest of your responsibilities is a taxing undertaking. 

Role of Medical Coders

Medical coders are akin to language translators in the healthcare world. They convert medical procedures, diagnoses, and services into codes from coding systems like ICD-10, CPT, and HCPCS. This translation process ensures that healthcare services are accurately represented, enabling efficient claim submission and accurate reimbursement.

Role of Medical Billers

On the other hand, medical billers are the liaisons between healthcare providers and insurance companies. Their responsibilities include verifying patient information, ensuring proper documentation, navigating insurance policies, and submitting claims. The precision of their work directly impacts the timeliness and accuracy of reimbursement.

Accurate coding and billing not only ensure fair compensation but also contribute to the overall sustainability and success of healthcare practices–it’s absolutely critical to the productivity and profitability of your practice. At PractiSynergy, we know how complicated this field is, and how hard it can be to get it right. That’s what we’re here for! In our next blog, we’ll continue our comprehensive guide so that you can get a better understanding of everything we do. 

Contact us today to learn more.

Medical Coding Guide

Veterans & Mental Health: What We Can Do

After commemorating our veterans earlier this month with Purple Heart Day, it’s important to remember that vets not only sacrificed their physical well being, but their mental health as well–something that has historically been overlooked and underestimated. The journey to mental well-being for our veterans is a shared responsibility that involves comprehensive support, understanding, and appropriate interventions. Veterans often confront unique mental health challenges stemming from their service experiences. What can we do about it?

Understanding Veterans’ Mental Health Needs:

Service-related experiences can lead to a range of mental health issues among veterans, including but not limited to post-traumatic stress disorder (PTSD), depression, anxiety, and substance abuse. These challenges highlight the need for specialized care and support that acknowledges the complexities of their situations.

Addressing Mental Health Needs Effectively:

The key to supporting veterans’ mental health lies in a multi-faceted approach that goes beyond medical treatments. While professional help is vital, holistic care considers various aspects:

Community Understanding: 

Fostering awareness about veterans’ mental health challenges helps remove stigma, making it easier for veterans to seek help without fear of judgment.

Accessible Resources: Ensuring veterans have access to a variety of resources, from 

counseling services to peer support groups, creates a safety net of support that acknowledges their unique struggles.

Tailored Interventions: Recognizing that each veteran’s experience is different, individualized treatment plans that consider their background, triggers, and preferences can significantly improve outcomes.

Our Role as Medical Professionals:

Medical professionals play a vital role in veterans’ mental health support. We can make a drastic difference in veterans’ quality of life if we address these patients and their unique needs effectively. 

Compassionate Care: A patient, empathetic approach helps create a safe space for veterans to open up about their experiences and challenges.

Accurate Diagnosis: Clinicians trained in veterans’ mental health concerns can provide accurate diagnoses that lay the foundation for appropriate treatment.

Collaborative Efforts: Collaborating with mental health specialists, community organizations, and veterans themselves ensures a comprehensive support system.

Additionally, in PractiSynergy’s role in assisting these medical professionals in keeping their practices productive so that they can continue to treat their patients effectively, we recognize that this can also present challenges in the medical billing and coding side of things. With complex diagnoses and societal stigma, accurately coding and documenting can be daunting. That’s what we’re here for. With successful and accurate coding, veterans can reap more benefits from their mental health care:

 Timely Access to Care: Accurate coding allows veterans to access mental health services promptly, reducing wait times and ensuring that their needs are met in a timely manner.

Comprehensive Treatment: Proper coding ensures that veterans receive comprehensive mental health treatment tailored to their specific conditions. This can include therapy, medication, and other interventions that contribute to their overall well-being.

Reduced Financial Burden: For veterans, mental health care costs can be a significant concern. Accurate coding helps veterans maximize their insurance benefits, reducing out-of-pocket expenses and easing the financial burden associated with seeking help.

Data Analysis and Improvement: Accurate coding generates reliable data that can be analyzed to understand veterans’ mental health trends and needs. This information is invaluable for healthcare providers and policymakers to improve services and allocate resources effectively.

Veterans have served our country, sacrificing their health and safety for the good of the nation and it’s citizens. The least we can do in return is recognize their unique struggles and treat their mental health as a matter of utmost importance, which requires a collective effort from society, medical professionals, and our community. While we are only a small part of that effort, PractiSynergy is proud to do our part by assisting fantastic medical practices with their medical billing and coding so that they can focus on their patients rather than payments. By understanding their unique challenges and providing holistic support that goes beyond medical interventions, we can create a compassionate environment where veterans feel heard, valued, and empowered on their path to mental well-being. 

Medical Coding Guide

How to Make Wellness Screening Codes Work for You

Did you know that you can earn additional revenue for your healthcare practice by utilizing wellness screening codes? Medicare and various insurance companies provide coverage for preventive services beyond the annual wellness visit in a primary care setting. By taking advantage of specific wellness screening codes, you can bill and get reimbursed for services like alcohol misuse screening, depression screening, and counseling for tobacco cessation. Here’s how PractiSynergy can help your practice identify and maximize billing opportunities.


Alcohol Misuse Screening & Counseling:

Alcohol dependence is a prevalent issue that affects many individuals. Medicare and other payers cover an annual screening for alcohol dependence. This screening is defined by certain criteria, including tolerance, withdrawal symptoms, impaired control, and preoccupation with alcohol use. If a patient meets the criteria, your practice can bill for this service once per year. Additionally, for those who screen positive for alcohol dependence, brief face-to-face behavioral counseling can be provided. Behavioral counseling interventions should follow the 5 A’s approach: Assess risk factors, Advise on behavior change, Agree on treatment goals, Assist with behavior change techniques, and Arrange follow-up or other treatment. This counseling service can be billed up to four times per year.

Depression Screening:

Depression is a common mental health condition that often goes undiagnosed. Medicare and other payers offer coverage for annual depression screenings lasting up to 15 minutes. To ensure accurate diagnosis, effective treatment, and follow-up, staff-assisted depression care supports, such as nurses or physician assistants, should be in place. Your practice can bill for this service once per year, allowing you to provide crucial mental health support to your patients while receiving reimbursement.

Counseling to Avert Tobacco Use:

Smoking and tobacco use cessation counseling is an essential service for patients using tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related diseases. Medicare Part B and other payers cover up to eight counseling sessions per year. By offering counseling to help patients quit tobacco, you not only improve their overall health but also increase your practice’s revenue through reimbursable services.


Utilizing PractiSynergy:

Identifying and maximizing billing opportunities for wellness screening codes can be a complex process. This is where PractiSynergy can assist your practice. PractiSynergy is a comprehensive healthcare management solution that helps practices optimize their revenue cycle management. With its advanced features and tools, PractiSynergy can identify the services you’re already providing that qualify for reimbursement and ensure proper billing. By leveraging PractiSynergy, you can streamline your billing processes and focus on delivering quality care to your patients while maximizing revenue.


Take advantage of the wellness screening codes offered by Medicare and other insurance companies to increase revenue for your healthcare practice. By billing and getting reimbursed for services like alcohol misuse screening, depression screening, and counseling for tobacco cessation, you not only provide essential preventive care but also optimize your practice’s financial performance. With PractiSynergy’s assistance, you can easily identify these billing opportunities and streamline your revenue cycle management. Start leveraging these reimbursement options today and see the positive impact on your practice’s bottom line!

Contact us today!

Medical Coding Guide

Increasing Payments When Rates Are Decreasing

PractiSynergy understands the challenges faced by healthcare providers in maximizing revenue. With governments tightening their budgets and insurance companies implementing complex reimbursement processes, it is crucial for medical practices to employ strategies that increase cash flow without overwhelming their staff. In this blog post, we will focus on one such strategy: Chronic Care Management (CCM).


What is Chronic Care Management (CCM)?

Chronic Care Management, as defined by the Centers for Medicare & Medicaid Services (CMS), refers to the coordination of care services provided outside of regular office visits for patients with two or more chronic conditions expected to last at least 12 months or until the patient’s death. CCM aims to address the needs of patients at significant risk of death, acute exacerbation/decompensation, or functional decline.


Reimbursable Opportunities for Providers:

Physicians, along with other healthcare professionals such as physician assistants, clinical nurse specialists, nurse practitioners, and certified nurse midwives, have the opportunity to bill for CCM services. However, it’s important to note that only one practitioner can be paid for CCM services per patient within a given calendar month. We recommend that only the provider responsible for the primary care of the patient bill for CCM services.


Understanding the Reimbursement Process:

CCM services are payable for a minimum of 20 minutes spent by clinical staff. Certain healthcare providers may also bill additional codes for extra time spent with patients. At PractiSynergy, we help medical practices determine which patients are eligible for these services and assist in creating a comprehensive plan to ensure all requirements for reimbursement are met.


Unlocking Additional Funds with CCM:

By documenting a few extra items in addition to the regular care provided to patients, medical practices can potentially qualify for additional funds through CCM reimbursement. PractiSynergy encourages healthcare providers to reach out and determine if they are eligible to leverage this opportunity.


How PractiSynergy Can Help:

At PractiSynergy, we understand the complexities involved in maximizing revenue and navigating the reimbursement landscape. Our team of experts will assist your practice in identifying eligible patients for CCM services and guide you through the process of implementing a reimbursable event. By partnering with us, you can streamline your billing and coding processes, allowing you to focus on providing quality care to your patients while optimizing revenue.

Contact us today!

Medical Billing Guide Medical Claim Adjustments

Top Three Reasons Your Claim Has Been Denied

When it comes to medical billing, the coding network can get quite tricky. There are many reasons your claim may be denied. This fault could fall on the provider or the payer. The more informed you are, the easier the claim process will operate. It’s important to cooperate with your medical coding professionals and give them the most accurate information possible to avoid a denied claim. The best way to avoid errors is to communicate efficiently.

Having a claim error can negatively impact your practice and harm revenue cycles. To achieve an optimum experience with patients, it’s important to make this process seamless and smooth. We’ve all heard the “a bad foundation builds a weak house…” analogy. Think of your medical billing system in such a way. The well-being of your business is one of your main priorities. It’s essential to maintain a strong base of medical coding to keep everything on the front lines running as it should. At PractiSynergy, our highly trained staff works closely with you to build that foundation. This way you can get back to what’s important, rather than stressing about coding errors. 

Furthermore, we’re here to divulge common errors leading to claim denials. Using our years of experience, we’ve gathered our knowledge to reveal the top three reasons we see claims get denied – and how to avoid them. 

  1. Claims not filed on time
    • Provider contracts with Insurance companies dictate how long from the date of service a claim can be filed
    • Traditional Medicare is 1 year
    • Many insurers have drastically shortened time to 90-180 days
    • You can appeal denials with proof you filed on time – these appeals also must be filed timely
  2. No Authorization or Exceeded Authorization Denials
    • Providers must know which procedures require prior authorization from the insurance company
    • Most insurers allow providers to submit for emergency authorization when procedures must be done – or allow for post-service review and authorization
    • Most insurers DO NOT allow providers to bill patients if the provider neglected to get a prior authorization
    • The authorization typically states a time frame when the procedure must be completed as well as the number of procedures or visits allowed
    • Appeals may be done if there is documentation that information received from the insurance company stated an authorization was not required.
  3. Claim errors and patient demographic errors
    • Coding errors happen – but there are ways to minimize these errors by building edits or macros into a practice management system
    • Patient intake forms – these forms are typically filled out by patients. As these forms have become electronic they tend to feed directly into the practice management system. This causes an immense amount of error since most patients do not know exactly what information they need off an insurance card or they may put a nickname that does not match the insurance database
    • All demographics need to match what insurance companies have on file or there is a high probability of claims being rejected or denied

By making sure your claims are authorized, reported on time, and fully reviewed before submission, you’re able to avoid the most common faults we see as medical billing professionals. Taking these proper precautions can help the well-being of your practice and its backend process. 

Using this data, we’ve formulated our business in a manner to avoid such errors. We ensure our clients get none of the stress and all of the cash flow. When we work together we’re able to take the stress of coding errors off your back. Get back to what you do best. It’s our passion to help you, so you can help others. To get informed about our medical coding and billing services, Call Katie at PractiSynergy or reach out via Email

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