What are the Red Flags in Revenue Cycle Performance?

Lack of accurate and regular KPI reporting Days in AR > 60 days Denial rates > 10% AR 90+days > 30% For everyone involved in healthcare finances, it is important to understand the red flags in revenue cycle management. For all healthcare providersa, revenue cycle is a key cog in cash flow and financial health. […]

COVID-19 Reimbursement for Uninsured Patients

Community Health Centers (CHC) are eligible for reimbursement for the testing and treatment of COVID-19 patients who are uninsured. The Families First Coronavirus Response Act (FFCRA) Relief Fund appropriated $1 billion to reimburse providers for conducting COVID-19 testing for the uninsured; and the Provider Relief Fund appropriated additional funds to reimburse providers for treating uninsured […]

Evaluation and Management (E&M) Coding Changes for 2021

CMS and the American Medical Association have announced big changes in E&M coding for 2021. These changes were implemented to help ease the burden of documentation requirements for providers. Currently E&M code selection is on a points-based system consisting of three key components: history, examination and medical decision making. Under the 1995/1997 rules, for each […]

United Healthcare to Require Anatomical Modifiers

Beginning with claims submitted on or after May 1, 2018, care providers will be required to include an anatomical modifier that identifies the area or part of the body for procedures performed on the eyelids, fingers or toes. This coding edit is consistent with Centers for Medicare & Medicaid Services (CMS) correct coding guidance and […]

Billing for Chronic Care Management

** UPDATE FOR 2017 ** An estimated 117 million adults have one or more chronic health conditions, and one in four adults have two or more chronic health conditions. Chronic disease is prevalent among Medicare beneficiaries, with most beneficiaries having multiple chronic conditions, which increases the risk for poor health outcomes such as mortality and […]

MACRA – Final Rule

Medicare Physician Billing Services for Raleigh, NC & West Palm Beach, FL Breaking: Medicare finalizes sweeping changes to physician payments Today, the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated final rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). With […]

ICD-10-CM Diabetes Mellitus Coding

The documentation of diabetes mellitus has made the classification and diagnosis of the disease easier. Diabetes mellitus is classified using these codes: [1] E08 Diabetes mellitus due to underlying condition: The underlying conditions can be:[1] Congenital rubella Cushing’s syndrome Cystic fibrosis Malignant neoplasm Malnutrition Pancreatitis and other diseases of the pancreas E09 Drug or chemical […]


The Centers for Medicare & Medicaid Services (CMS) recently published some facts about ICD-10 intended to dispel myths and address common questions about the upcoming transition: The ICD-10 transition date is October 1, 2015 – The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the […]

Medicare News!! SGR Repealed, 21% Cut Averted

On Tuesday, April 14th, the Senate voted to approve the Medicare Access and CHIP Reauthorization Act, H.R. 2. This legislation, which passed the House of Representatives on March 26, permanently repeals the Medicare Sustainable Growth Rate (SGR) formula. President Obama will sign the bill into law. In addition to SGR repeal, the law includes three […]


Excerpt from MedLearn Matters article MM9051, revised 12/31/2014, implementation date 2/2/2015 The Centers for Medicare & Medicaid Services (CMS) is updating the Medicare coverage requirements to align with the updated ACIP recommendations. Effective for dates of service on or after September 19, 2014, (and upon implementation of CR9051), Medicare will cover: An initial pneumococcal vaccine […]