Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Why Total AR Tells You Almost Nothing: Reading AR Aging by Payer
A single days-in-AR figure hides more than it shows. Here is how to build and read an AR aging report by payer class, the benchmarks that apply to each bucket, how to separate payer slowness from practice slowness, and the weekly worklist that comes out of it.
The CPT 2024 Code Set Is Out: 349 Changes and What to Plan Before January 1
The AMA has released CPT 2024, with 230 new codes, 49 deletions and 70 revisions, including new RSV immunization codes and caregiver training services. Here is how to turn a code book release into a practice-level plan for the January 1 changeover, without waiting for the December scramble.
UnitedHealthcare and Cigna Cut Prior Authorization: What Changes in Practice
UnitedHealthcare published the codes it will stop requiring authorization for on September 1 and November 1, 2023, about a fifth of its volume. Cigna followed on August 24 with more than 600 codes. Here is what is actually changing, what is not, and how to adjust the authorization workflow without creating new denials.
How to Load Payer Fee Schedules Into Your Billing System and Keep Them Current
You cannot find underpayments against a fee schedule you never loaded. Here is how to get contracted rates out of the contract and into the system: the fields that matter, the Medicare-percentage trap, a load and test sequence, and the calendar that keeps the schedules from going stale.
Month-End Close for a Medical Practice: What to Reconcile and in What Order
Most practices produce a month-end report without doing a month-end close. Here is the difference, the six reconciliations that make the numbers trustworthy, a realistic five-day calendar, a worked example, and the errors that quietly distort every report the owner reads.
CMS Proposes the 2024 Fee Schedule: G2211 Arrives, the Conversion Factor Falls
CMS released the CY 2024 Physician Fee Schedule proposed rule on July 13, 2023. It would cut the conversion factor by about 3.3% and finally pay for the G2211 visit complexity add-on. Here is what changes for independent practices and what to do before comments close on September 11.
Writing Denial Appeal Letters That Actually Get Read and Overturned
Most appeal letters fail before a reviewer reaches the second paragraph. Here is the structure we use, the three denial types where a letter is worth writing, the documents to attach, the deadlines to log, and the mistakes that get an otherwise good appeal sent back unread.
Billing Staffing Shortages in 2023: Running the Revenue Cycle With Fewer People
MGMA polling this spring found coders and billers are the hardest revenue cycle roles to fill, and turnover in business operations staff topped 33% last year. Here is how the practices coping best are cutting rework, automating the repetitive checks, cross-training, and deciding what to send out.
ChatGPT in the Billing Office: What Generative AI Can and Cannot Do in 2023
Six months after ChatGPT launched, billers and practice managers are already pasting denial letters into it. Some of that is useful and some of it is a privacy incident. Here is what these tools do well today, where they fail at coding and payer rules, and the three-rule policy every practice should write this month.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.