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Category Archives: Revenue Cycle Management

Be prepared for radiology coding changes in 2017

Get ahead the changes of radiology-specific in 2017. Mammography codes are overhauled and summarized.

Changes in Mammography Codes 2017

New Codes Description Deleted Code
77065 Diagnostic mammography, including CAD when Performed; unilateral 77055 / 77051
77066 Diagnostic mammography, including CAD when performed; bilateral 77056 / 77051
77067 Screening mammography, bilateral (2-view study of each breast), including CAD when performed 77057 / 77052

 

Determine what new evolving technologies may or may not be coded in 2016.

CPT Category III codes mostly do not have a customary payment amount per CPT guidelines, however, if a Category III code is available, you must report it instead of a Category I unlisted procedure code.

Find below Category III code changes for 2016.

0381T External heart rate and 3-axis accelerometer data recording up to 14 days

0382T review and interpretation only

0383T External heart rate and 3-axis accelerometer data recording from 15 to 30 days

0384T review and interpretation only

0385T External heart rate and 3-axis accelerometer data recording more than 30 days

0386T review and interpretation only

Leadless Pacemakers

There are five new codes to describe services related to permanent leadless pacemakers:

0387T Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular

0388T Transcatheter removal of permanent leadless pacemaker, ventricular

0389T Programming device evaluation in person with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report, leadless pacemaker system

0390T Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless pacemaker system

0391T Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system

CPT® Changes 2016 advises, “Existing CPT codes only addressed procedures for traditional pacemaker systems and did not adequately describe the procedure of implanting a leadless pacemaker. Therefore, these codes have been established to report leadless and pocketless system procedures.”

Esophageal Sphincter Augmentation

Esophageal sphincter augmentation is performed for treatment of gastoesophageal reflux disease (GERD). The device employs magnets, placed around the gastroesophageal junction. The attraction of opposing magnets narrows the opening, but allows food to pass when the patient swallows.

0392T Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band)

0393T Removal of esophageal sphincter augmentation device

Experts LRN’s seamless effort Overturned denied claims for payment.

Bristol healthcare services partnered a FL Medical billing company this May 2016 to clear a huge backlog of +18,000 accounts to move for the next level.  We were able to identify most of the claims denied resulting insufficient medical notes, we know these denials are recoverable through the filing of effective appeals.  With experts in mind Bristol Healthcare Services partnered with remote registered nurse to navigate these complex appeals process for them to overturn denied claims for payment and to reduce unnecessary write-offs.  Our onsite licensed RN’s carefully review medical records to effectively prepared and sent appeals from the start to resolution.  We acted as an extension of the medical practice along with the RN’s using their working knowledge of various payer authorization requirements, medical criteria and protocols necessary to make the case for successful appeals.  In addition to clinical experience, our team offered follow-up and support during the adjudication process as needed to overturn even difficult denied claims paid.

Healthcare Ancillary services – Engage and identify the possibilities to overcome

Take a look at the Bristol Healthcare Services recommends feature, or request a demo of our Services.  There is no one-size-fits all solution, so Bristol Healthcare Services developed a number of different ways for you to get the insights you need.

Ancillary healthcare services refers to the wide range of services to single / Group physicians, Healthcare Facilities, Diagnostic lab’s and other healthcare entities.

Many a times, physicians have to deploy resources such as capital, equipment, software and admin staffs to deal with insurance reimbursement delays.  More often than not, some of these issues can be avoided if only the credentialing process had been carried out properly and thoroughly.

  • Credentialing services
  • Fee schedule negotiation
  • Medicare Revalidation
  • Clearing house / EDI and EFT setup

Why a Periodic Visit to the Physician office?

1. General Health check-up

Staying up to date with recommended vaccinations and screenings is a vital part of good health. Periodic health exams and treatment is important because it not only improves the overall prognosis of the disease, but also provides the best opportunity for a cure.

2. Knowing Your Records

Do you know what your cholesterol or blood pressure is? More than 50% of Americans have never had their cholesterol checked. Given that 33.5% of American adults have elevated “bad” cholesterol, and that having high total cholesterol approximately doubles the risk of heart disease, it’s important to get a jump on these numbers. Meanwhile, 31% has high blood pressure, which is a known risk factor for heart attacks, strokes, and kidney disease. Cholesterol and Blood pressure check be responsible for a baseline to compare to over time, so it’s valuable to obtain these numbers while you’re still considered young and healthy. If nil, you can print out the numbers and use them as motivation to be healthier and beat them next year.

3. Crafting Your Medical Record

Periodic visits to the doctor are a chance to update your personal medical record. Most clinics and hospitals apply an EMR to store health information. These histories are important because they are readily available to affiliated hospitals in the event of an emergency.

4. Patient Relationship – Establishing a Trusting Doctor

One of the most blessed parts of medicine is the doctor-patient relationship. This relationship is not built instant, but requires multiple interactions to allow the doctor to really understand the patient. This is particularly important because it can affect the treatment that is prescribed. It is not until a physician understands a patient’s history and values that he or she can help to the best of their abilities. Another major benefit of being an established patient is that most practices have 24/7 help lines; so when it’s weekend night with no one around and nothing open, patients still have access to a familiar physician whom they can call for help.

5. (Effectively) Free Prevention!

Even the most basic insurance companies typically cover the cost of an annual preventive care visit, including necessary lab tests. There might be small co-pay at the time of the visit, but this is usually not more than $25. Physician will meet one-on-one to discuss your personal health needs and concerns. Talk about VALUE FOR THE MONEY SPENT!

Reward – Hello Member here is your Reward

Dear Member, Welcome to Dr.____________________________________ office.

Our aim is to provide high standard of healthcare within the scope of available resources. We recognize the benefit in keeping our members well informed and involved in both their own care and that those whom they care for at home. Please ensure that an urgent appointment with Doctor will be given within _____ hours. Also, you can cancel or change your Active Medical appointment without incurring any fees, as long as you give us at least 24 hours in advance. To cancel or change your appointment please phone us on (_____)- ______-______ so that it can be offered to someone else.

FAILING TO ATTEND APPOINTMENTS IS WASTE OF RESOURCES

Revenue Cycle Management – Getting Paid on Time

An effective Revenue Cycle Management helps practices to increase efficiency and revenues. It also ensures to cut cost and reduce denials considerably. Revenue Cycle Management is not about just one activity, it is all about managing the entire process from start to finish. In the healthcare setting Revenue Cycle Management begins even prior to a patient’s visit to the facility.

Pre-verification is the first step in Revenue Cycle Management. All the patients scheduled to visit the provider are verified for eligibility and benefits with their insurance. All authorization and referral requirements are clearly understood and documented. Co-pay, Deductibles and out of pocket expenses are also documented. First step to effective Revenue Cycle Management begins with collecting the patient liabilities immediately during the visit. (more…)