What’s New for ICD-10 in 2021?

It’s that time of year again. On October 1, 2020, the annual update to ICD-10 codes goes into effective. Just a reminder—there is no grace period. Use of deleted or invalid diagnosis codes will result in claim denial and delay payment. The ICD-10-CM Official Guidelines for Coding and Reporting FY 2021 (October 1, 2020 – September 30, 2021) have also been updated. These are provided by the Centers for Medicare and Medicaid Services with the National Center for Health Statistics.   COVID-19 The coding guidelines regarding COVID-19 have been added …
Read More

Clearing Up the Confusion in COVID-19 Testing

There are so many options available for coronavirus disease 2019 (COVID-19) testing. How do you know what test is best for your urgent care center? The need for virus testing was and still is paramount in the fight against this COVID-19 pandemic. The American Medical Association introduced new Current Procedural Terminology (CPT) code 87635, “Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19)], amplified probe technique” on March 13, 2020, also making the code effective that same date of service …
Read More

The Myth of ‘Control’ with In-House Billing

We keep our billing in-house so we can control it. I have been in the revenue cycle management (RCM) business for over 25 years and I guess I have heard this quote from people more than a thousand times. Unfortunately, 95% of the time it is just not true! Having your billing staff in the clinic may make you feel better but, in most cases, there is no control at all. It is just a false sense of security. Consider that actually being in control includes all of the following: …
Read More

The Impact of Public Health Emergency on Revenue Cycle Management

March and April were challenging months for all of us, and the revenue cycle management arena is no exception. A few months ago, we never would have imagined that our everyday lives would grind to such a halt—from schools, sports, concerts, and events canceled to self-quarantines and stay-in-place mandates. The financial markets have lost tremendous value and many people have lost or will likely lose their jobs. In all of this craze, we have seen our urgent care customers rise to the occasion to support their communities and show amazing …
Read More

Contracting and Credentialing: A Complex Obstacle to Navigate

The terms contracting and credentialing are often used interchangeably, but the processes involved in each, while interdependent, are very different and have different outcomes. Contracting, in brief, is the process of creating a formal legal agreement between the payer (insurance company) and the provider (facility, physician, and/or physician extender). The contract outlines expectations and requirements of all parties. The effective date of the agreement, the reimbursement/fee schedule, place of service, termination clauses, services allowed and disallowed, etc. are all included in a typical contract. Credentialing with payers is the process …
Read More
Loading...