HHS Finalizes Medicare Payment Rule for 2025: The Reality Behind Cuts and Telehealth Rollbacks
This guide covers 2025 Medicare physician fee schedule for independent practice owners: what it is, why it matters, and what to do next. The Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) have rolled out the new Medicare Physician Fee Schedule (PFS) for 2025, with some changes […]
Pediatric Billing Cheat Sheet: CPT Codes, Modifiers, and Denials
Quick answer The pediatric CPT codes that drive most revenue are well visits (99381–99385 new, 99391–99395 established), vaccine administration (90460–90461 with counseling, 90471–90474 without), developmental screening (96110), and sick visit E/M codes (99212–99215). Most pediatric denials come from two things: a missing modifier 25 when a sick visit is billed on the same day as […]
STOP Leaving Money on the Table with Eligibility Denials
This guide covers eligibility denials for independent practice owners: what it is, why it matters, and what to do next. You can’t control insurance companies. BUT YOU CAN CONTROL THIS!!! When it comes to running a healthcare practice, verifying insurance is one of those crucial yet often overlooked processes that can make or break your […]
Why You Need to Update Your CPTs and ICD-10 Codes Annually
This guide covers update CPT and ICD-10 codes for independent practice owners: what it is, why it matters, and what to do next. In today’s fast-paced healthcare environment, staying current with the latest medical coding updates is more important than ever. As a healthcare provider, ensuring that your practice’s systems are up to date with […]
How to Fix: Bank Deposits Matching EHR Postings
This guide covers payment posting for independent practice owners: what it is, why it matters, and what to do next. Managing the financial aspects of a medical practice can be complex, especially when it comes to ensuring that the payments recorded in your Electronic Health Records (EHR) or Practice Management (PM) software align with the […]
Understanding Denied vs. Rejected Claims in Medical Billing
This guide covers denied vs rejected claims for independent practice owners: what it is, why it matters, and what to do next. Medical billing is a critical process in healthcare, ensuring that providers get paid for their services. However, navigating the complexities of insurance claims can be challenging, particularly when dealing with denied and rejected […]
The Importance of a Business Case in Healthcare Decision-Making
This guide covers business case in healthcare for independent practice owners: what it is, why it matters, and what to do next. In the rapidly evolving landscape of healthcare, making informed and strategic decisions is more critical than ever. Whether you’re contemplating the purchase of new medical equipment, considering an expansion of services, or implementing […]
Billing Tip for Pediatric Immunizations
This guide covers pediatric immunization billing for independent practice owners: what it is, why it matters, and what to do next. Fellow healthcare providers, when we encounter pediatric patients who are behind on their immunizations, it’s crucial to understand the appropriate billing practices for immunization counseling and administration. 📝 Key Points for Accurate Billing: 📊 Efficient Practice […]
CMS Update on Shared or Split Services
The landscape of medical billing and compliance continues to evolve, with the Centers for Medicare & Medicaid Services (CMS) and the Current Procedural Terminology (CPT) introducing significant updates to the shared or split services policy in 2024. These changes, which expand the definition of split/shared services and modify the requirements for service billing and documentation, […]
Leveraging CPT Codes for Enhanced Medical Billing
Quick answer CPT 99223 is the highest level initial hospital inpatient or observation visit. Since 2023 you pick it by medical decision making (high) or by total time of 75 minutes or more on the date of the visit. The most common reason it gets downcoded is a note that does not show high-complexity decision […]