Examining Annual Deductibles and Simplifying In-Office Collection by Raja Chandra A Brief Introduction to Yearly Deductibles  The deductible is the patient’s out-of-pocket payment for healthcare services before insurance coverage starts. The Medicare Part B annual deductible for 2024 is $240.00.  ABC’s Deductible Collection Strategies.  Verify Insurance Information: ABC provides training to the front-office staff on the verification of insurance information, including deductible amounts, to educate patients about their financial obligations.   Clear Comm ..read more

Understanding Modifier 25 and Modifier 24: Differences and Uses in Medical Billing Modifier 25  Modifier 25 is a billing modifier used in the healthcare industry to indicate that a significant, separately identifiable evaluation and management (E/M) service was performed by a healthcare provider on the same day as another procedure or service.  It is used when a patient’s visit involves both a distinct E/M service, such as a consultation or office visit, as well as a procedure or other service, such as a minor surgery or diagnostic test.   To qualify for modifier 25&nbs ..read more

2024 Medicare Physician Fee Schedule Proposed Rule Key Points On July 13th, the Centers for Medicare and Medicaid Services (CMS) published the 2024 Medicare Physician Fee Schedule proposed rule (PFS) which includes proposed Medicare Part B payment policies for the coming calendar year.  CY 2024 Conversion Factor  The proposed Calendar Year (CY) 2024 PFS Conversion Factor (CF) is $32.75, a reduction of $1.14 compared to the 2023 PFS CF of $33.89  The proposed Anesthesia CF is $20.44, a reduction of $0.68 compared to the 2023 Anesthesia CF of $21 ..read more

SCAI 2022 Scientific Sessions Every year, SCAI Scientific Sessions brings together the interventional cardiology community from around the world to share the latest clinical data, procedural guidance, and advanced expertise in the field.  Apple Billing and Credentialing had booth at SCAI scientific session 2022 to exhibit ABC’s medical billing and credentialing services. Raja Chandra the President & Founder of Apple Billing and Credentialing met several interventional cardiologist during the session in Atlanta, GA. Raja Chandra was able to empower several providers and practice ma ..read more

SCAI 2022 Scientific Sessions Every year, SCAI Scientific Sessions brings together the interventional cardiology community from around the world to share the latest clinical data, procedural guidance, and advanced expertise in the field.  Apple Billing and Credentialing had booth at SCAI scientific session 2022 to exhibit ABC’s medical billing and credentialing services. Raja Chandra the President & Founder of Apple Billing and Credentialing met several interventional cardiologist during the session in Atlanta, GA. Raja Chandra was able to empower several providers and practice ma ..read more

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Insurance claim rejections and its followup Invalid member name, date of birth or identification number Policy canceled or coverage terminated Invalid or obsolete ICD 10 diagnosis code Non specific ICD code posted for CPT 93306 External cause code cannot be used as Principal Diagnosis code Relationship to insured must be 18 – Self for Medicare The payer has received the exact claim or service before Hospitalization date missing or invalid Date of service invalid Subscriber Postal/Zip code invalid [contact-form-7] Invalid member name, date of birth or identification number Rejection f ..read more

E&M code updates of 2021 Medicare and Medicare Advantage plans are adopting the new E&M codes starting from 01/01/2021. However commercial insurances usually follow CMS and AMA guidelines, they are not required to adopt the new changes.   Key takeaways 99201 and 99211 are obsolete for 2021 ALL E&M codes should be coded based on time spent or MDM (Medical decision making) Time spent is defined as total time spent, including non-face-to-face (documentation) work done on that day. Changes in time range CPT Code Time range (in mins) MDM Non-Facilit ..read more

How to avoid medical records request from United Healthcare United Healthcare requests medical records for most of the claims. After our deep analysis we found that if the total claim charge amount is more than $1,300 UHC is requesting medical records. We tried two claims for different patients with the same procedure but one with a total charge amount above $1,300 and other less than $1,300. United Healthcare requested a medical record for the claim with above $1,300 and paid the claim below $1,300 according to the contract. Rather than doing further analysis if the UHC medical records r ..read more

Fee schedule analysis and auditing                     The insurance allowed amount or the fee schedule is determined by various factors such as insurance plan, provider in-network or out of network status, ACO, PHO, geographic practice cost index, etc. If the practice did not keep up with the ever-changing fee schedule there is a good chance to lose revenue by charging lower than what is allowed.                      We constantly analyze each Commercial, Medicare, and Medicaid fee sch ..read more