#medical billing and coding

[samanthasgone]

I started online school for medical billing and coding from the same trade school I graduated as a medical assistant 10 years ago. I just finished the 1st week and 33 weeks to go.

[ivarinleatherpants]

I haven't been able to see The Pitt myself yet, but someone tell me there's a FOIR case. It isn't a realistic ER without one.

[medicalbillingcompanyusa]

Patient privacy is more than a legal obligation—it’s a foundational trust factor between providers and patients. That’s where HIPAA, or the Health Insurance Portability and Accountability Act, steps in.

Originally enacted in 1996, HIPAA was designed to protect sensitive patient data from unauthorized access and breaches. But its importance has grown exponentially with the rise of digital health records and third-party service providers.

So, why is HIPAA-compliant is important for billing? Because medical billing companies handle enormous amounts of patient data—from demographics to diagnosis codes and insurance details. Without the right protections, even a minor oversight can lead to serious consequences.

Click for more: Why HIPAA Compliant Matters in Medical Billing

[bloglynk]

Get expert medical coding services in USA and streamline your revenue cycle management.

[inficareservices]

Boost revenue with our leading medical billing company! We offer accurate claims processing, faster reimbursements and hassle-free billing solutions to maximize your practice’s profitability. #MedicalBilling #MedicalBillingServices #MedicalBillingandCoding

[mososimos]

Tips for Podiatry Medical Billing and Coding

Podiatry clinics face specific medical billing issues due to the challenges of categorizing various foot-related illnesses and different insurance coverage. Leveraging professional medical billing services can help providers can maintain their financial viability by streamlining claim submission, lowering risk of claim denials, and increasing revenue. Watch this video: https://www.youtube.com/watch?v=nVRZ7Lbfr8A

[naveenthoughts]

CPC COACHING CENTERS IN HYDRERABAD

Thought Flows Academy, revolutionizing medical coding education since 2016, is the preferred destination in Hyderabad. As the top medical coding training institute, our 20,000 success stories and advanced CPC coaching centers make us the epitome of success in south India. Join our 6-year legacy of shaping skilled professionals and unlocking endless opportunities.

[ivarinleatherpants]

This triggers what is called an MUE, or a Medically Unlikely Edit. In this case, each orchiectomy is billed as a separate unit because it's more common for the procedure to be done to remove one (for cancer and such). But it is highly unlikely for someone to have three testicles, so it sends up an immediate flag for the insurance to kick it back for review.

Note, it's always medically unlikely. We never rule out the possibility of someone having a third testicle, because human bodies are fun like that.

gender-affirming surgery is a months-long dark comedy. what the fuck do you mean you're charging me double for everything. what do you mean they itemize the bill by left and right ball. what the fuck.

[atrastvala]

Frustrated and disappointed, but not surprised my first bite at a medical billing and coding job offer is a fucking scam. I hate it here.

[allzonems]

Top 10 Medical Coding Errors in 2025 and How to Prevent Them

The world of medical billing and coding is evolving rapidly. In 2025, new technologies, shifting payer guidelines, and the ongoing transition to value-based care have brought both major advancements and new challenges. Amid these changes, one issue continues to plague healthcare providers: medical coding errors.

From claim rejections and payment delays to compliance risks and revenue leakage, coding errors can have costly consequences. This guide—created by experts in medical coding services—dives into the Top 10 Medical Coding Errors in 2025, and offers clear, actionable strategies to eliminate them.

If you're a healthcare administrator, coding professional, or part of a medical coding company, this guide will help you improve accuracy, minimize denials, and enhance compliance across the revenue cycle.

1. Upcoding and Downcoding: Misrepresentation of Services

The Problem: Assigning codes that inaccurately reflect the level of care provided—either too high (upcoding) or too low (downcoding).

Causes:

Misreading documentation

Revenue pressure or audit fear

Lack of education

Impact:

Denials, audits, legal risks

Solutions:

Documentation training for providers

Quarterly internal audits

NLP tools to assist in code selection

2. Incomplete or Missing Documentation

The Problem: Insufficient clinical detail leads to coding inaccuracies.

Causes:

Clinician time constraints

Inadequate EHR templates

Communication gaps between coders and providers

Impact:

Increased denial rates

Delayed payments

Compliance issues

Solutions:

Tailored EHR prompts

Team-based query culture

Monthly documentation workshops

3. Incorrect Use of Modifiers

The Problem: Misused or omitted modifiers can change the meaning of procedures, affecting reimbursements.

Solutions:

Quick-reference modifier charts

Quarterly training by specialty

Software alerts for incorrect modifier use

4. Using Outdated Codes

The Problem: Failing to update CPT, ICD-10-CM, or HCPCS codes annually results in claim rejections.

Solutions:

Subscribe to CMS, AMA updates

Annual training for coders

Software audits to catch obsolete codes

5. Lack of Specificity in Diagnosis Coding

The Problem: Using unspecified codes when a specific diagnosis is available hurts both revenue and care quality tracking.

Solutions:

Coders should issue clinical queries

Dashboards to track provider specificity

AI-based code suggestion tools

6. Unbundling Services That Should Be Billed Together

The Problem: Reporting bundled procedures separately to increase reimbursement leads to compliance issues.

Solutions:

Integrate NCCI edit checks

Create specialty-specific bundling guides

Peer reviews within coding teams

7. Errors in Telehealth Coding

The Problem: Constantly changing payer rules make telehealth coding prone to error.

Solutions:

Maintain a payer-specific telehealth resource

Conduct regular telehealth compliance training

Use checklists before claim submission

8. Incorrect Principal Diagnosis Assignment

The Problem: Incorrect sequencing in inpatient claims leads to DRG misclassification and underpayment.

Solutions:

Conduct random audits

Train on UHDDS guidelines

Improve physician documentation clarity

9. Duplicate Billing

The Problem: Submitting the same claim more than once—either by accident or system error.

Solutions:

Automated claim scrubbers

Verify status before re-submitting

Reconciliation tools for encounter-to-charge matching

10. Not Adhering to Payer-Specific Rules

The Problem: Each payer has unique coding, billing, and documentation rules.

Solutions:

Maintain a live payer policy manual

Weekly email updates on payer changes

Analyze denial trends for targeted education

Bonus Tips for 2025 Coding Excellence

✅ Invest in Smart Technology

Medical coding companies that use AI, computer-assisted coding (CAC), and predictive analytics can significantly boost accuracy and efficiency—when combined with expert oversight.

✅ Commit to Ongoing Education

Top medical coding services invest in continuous learning. Stay updated with AAPC, AHIMA, CMS, and payer alerts. Regular team huddles can reduce costly errors.

✅ Encourage Clinical Understanding

Coders must go beyond guidelines to understand clinical intent. Host cross-training with providers to close the gap between documentation and accurate coding.

✅ Track and Improve KPIs

Use coding performance metrics such as:

Coding accuracy rate

Coding-related denial rate

Query turnaround time

DRG mismatch trends

These metrics help identify gaps and training needs—enabling your medical coding company or internal team to continuously improve.

Final Thoughts:

Whether you're a hospital, private practice, or part of a growing medical coding company, reducing errors in 2025 requires a proactive, tech-enabled, and education-driven approach. By implementing these strategies and partnering with the right medical coding services, healthcare organizations can achieve accurate coding, faster reimbursements, and stronger compliance.

For more information: https://www.allzonems.com/top-10-medical-coding-errors/

[devikri]

Understand the full medical transcription process at Transorze Calicut. Practical learning with skilled trainers.

[outsource-medical-billing]

When to Use Modifier 24 vs Modifier 25: Examples and Billing Guidelines

In the realm of medical billing, even a small coding mistake can lead to denied claims, delayed reimbursements, or an increased likelihood of audits. One of the most frequent issues arises from the incorrect use of modifiers—especially Modifiers 24 and 25. These modifiers play a vital role in accurately reporting evaluation and management (E/M) services provided alongside surgical procedures. However, they are often misinterpreted or improperly applied. Such errors can result in claim rejections, compliance concerns, and financial setbacks for healthcare practices.

This blog offers a comprehensive overview of how to correctly use Modifiers 24 and 25, along with essential medical billing and coding guidelines every provider should know.

Modifier Overview:

Modifier 24 is applied when a patient receives an evaluation and management (E/M) service during the global period of a previous surgery, but for a condition that is completely unrelated to that surgical procedure. This modifier is exclusive to E/M codes and signifies that the visit is not part of the routine post-operative care or complications arising from the surgery. It is frequently used in specialties such as surgery, ophthalmology, and optometry. To apply Modifier 24 correctly, the provider must clearly document a different diagnosis and explain why the service is unrelated to the prior procedure.

Modifier 25 is used when a healthcare provider delivers a significant and separately identifiable E/M service on the same day as another procedure. This is applicable when the evaluation addresses additional concerns beyond the usual care associated with the procedure. Modifier 25 is commonly used in primary care, dermatology, emergency medicine, and other similar fields. Accurate use of this modifier requires that the service is medically necessary, clearly documented as distinct, and justified, even if it involves the same diagnosis as the procedure.

When to Apply Modifier 24:

Assessment for a New, Unrelated Issue

Modifier 24 is appropriate when a patient is in the global post-operative period but returns with a health concern that is completely unrelated to the initial surgery. Example: A patient who recently underwent hernia surgery comes back within the 90-day global period due to a urinary tract infection. Since the condition is unrelated to the surgical procedure, Modifier 24 should be reported.

New Symptoms in a Different Area of the Body

Use Modifier 24 if the patient presents with symptoms affecting a body region that was not involved in the surgical procedure. Example: A patient who had cataract surgery two weeks ago now complains of shoulder pain. As the complaint is unrelated to the eye surgery, Modifier 24 is justified.

Condition Involving the Opposite Organ or Side

This modifier is also applicable when care is provided for a condition that affects the same system but occurs on the opposite side or a different, unrelated area. Example: If a patient had surgery on the left eye and later develops a new issue in the right eye, Modifier 24 is appropriate because the two issues are separate.

Unrelated Co-Management Evaluations

If a provider who is co-managing a post-operative patient’s care also evaluates a separate, unrelated issue, Modifier 24 must be used. Example: An optometrist managing a patient’s cataract recovery examines the other eye for a different vision concern. Since this issue is unrelated to the surgical procedure, the use of Modifier 24 is correct.

Ongoing Care for an Unrelated Chronic Condition

Modifier 24 should be used if the patient is being seen for routine management of a chronic condition that is unrelated to the recent surgery. Example: A patient recovering from gallbladder surgery comes in for regular diabetes follow-up. As this care is not associated with the surgery, Modifier 24 is appropriate.

When to Apply Modifier 25:

Evaluation That Results in a Procedure

Modifier 25 should be appended when a provider performs an evaluation and management (E/M) service to assess a patient’s complaint, which then leads to a medically necessary procedure during the same visit. Example: A patient experiencing sinus discomfort undergoes a full evaluation, and based on the findings, the provider performs a nasal endoscopy.

New Concern Raised During a Planned Procedure Visit

Apply Modifier 25 if a patient arrives for a scheduled procedure but also mentions a separate issue that needs to be evaluated independently. Example: A patient comes in for wart removal but also complains of stomach pain. The provider conducts a separate evaluation for the abdominal concern. Modifier 25 is applicable here.

New Problem Identified During a Preventive Exam

If a preventive check-up leads to the discovery of a new medical issue that warrants its own diagnostic workup, Modifier 25 should be used for the problem-focused E/M service. Example: A patient undergoing a routine wellness visit reports shortness of breath. The provider conducts additional evaluation, making Modifier 25 appropriate.

Urgent or Emergency Visit with an Added Procedure

In cases where both a significant evaluation and a medically necessary procedure are performed during a walk-in or emergency visit, Modifier 25 should be reported. Example: A patient presents with lower back pain that radiates to the legs. After assessing the condition, the provider gives an intramuscular injection. If the procedure qualifies under status indicators (S, T, Q1–Q3), Modifier 25 must be used with the E/M code.

Separate Conditions Managed in One Visit

Use Modifier 25 when the provider treats a condition different from the reason for the scheduled procedure. Example: A patient is seen for urinary symptoms but also has a skin lesion removed during the same visit. If each service is properly documented and individually addressed, Modifier 25 is appropriate.

Billing Guidelines:

Modifier 24:

Modifier 24 is only applicable to Evaluation and Management (E/M) codes and should not be used with surgical or procedural codes, no matter the circumstance.

If a provider from the same group and specialty sees the patient during the global period, Modifier 24 is still valid, since many insurers, including Medicare, consider these providers as one and the same for billing purposes.

Documentation must clearly demonstrate that the visit is for a completely unrelated issue to the original surgery. The notes should include the patient's symptoms, diagnosis, and a treatment plan specific to the new condition.

Do not use Modifier 24 for follow-ups related to surgical complications or routine post-operative care, such as wound checks, expected pain, or infections. These services fall under the global surgical package.

Modifier 25:

For Modifier 25 to be reimbursed separately under Medicare, the procedure performed during the same visit must have a status indicator of S, T, or Q1–Q3. If the indicator is N (packaged), the E/M service cannot be billed separately.

Even when an E/M service is justified, poor documentation may lead to claim denials or audits. Ensure your notes clearly outline the separate findings, assessments, and clinical decisions that support the additional service.

If a new issue is addressed during a preventive check-up, apply Modifier 25 only to the problem-oriented E/M code, not the preventive code itself.

Excessive or improper use of Modifier 25, especially without robust documentation, may result in payer audits or allegations of upcoding. Use it only when medically necessary and well-documented.

Modifier 25 can be applied when E/M services are performed alongside both simple and complex procedures, as long as the E/M effort goes beyond what is typically included in the procedure.

Conclusion:

While it may seem challenging at first, properly applying Modifiers 24 and 25 in E/M Coding can becomes much easier with a good understanding of the global period and coding rules. Correct use helps ensure appropriate reimbursement, reduces claim denials, and protects against compliance issues. Avoid common pitfalls, such as using both modifiers together or pairing them with unrelated ones.

To reduce errors and boost billing efficiency, it’s essential to work with trained and up-to-date coders. A smart approach is to outsource your billing and coding tasks to professionals like 24/7 Medical Billing Services. Our certified experts stay current with the latest changes in the industry.

Call us today at +1 888-502-0537 or email us at sales@247medicalbillingservices.com to learn how we can streamline your practice’s billing process.

Content Source: [https://www.247medicalbillingservices.com/blog/when-to-use-modifier-24-vs-modifier-25-examples-and-billing-guidelines]

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[mososimos]

Five Common CDT Coding Mistakes

Identifying the most common CDT coding mistakes is a crucial first step toward enhancing claim accuracy and ensuring a healthy revenue cycle.To stay compliant and avoid costly CDT coding mistakes, many dental practices turn to professional dental billing services that ensure precise coding and documentation. https://www.outsourcestrategies.com/blog/most-common-cdt-coding-mistakes/

[medical-billing-wholesalers]

MBW RCM Patient Access: Insurance Verification & Prior Authorization

Efficient patient access is the cornerstone of a successful revenue cycle. At MBW RCM, we understand that the first step in the revenue cycle — verifying insurance and obtaining prior authorizations — can determine the speed and accuracy of reimbursement. Our Patient Access Solutions are designed to minimize claim denials, reduce administrative burden, and create a seamless experience for patients and providers alike.

1. Why Patient Access Matters in Revenue Cycle Management

Patient access is more than just registration. It includes every process that occurs before a patient visit or procedure, directly affecting revenue integrity. When insurance verification or prior authorization is missed, delays, rework, and denied claims become common, impacting both cash flow and patient satisfaction.

2. Comprehensive Insurance Verification Services

MBW RCM offers end-to-end insurance eligibility verification services that check a patient’s coverage, copays, deductibles, and policy limitations in real-time. By integrating advanced tools and payer-specific protocols, we help clients avoid delays and improve clean claim rates from the start.

Explore more on our Revenue Cycle Mid-Cycle Services that complement patient access functions.

3. Streamlined Prior Authorization Management

Obtaining prior authorization can be time-consuming and complex, especially for high-cost procedures. Our team of trained professionals works with all major payers to ensure the right documents and clinical codes are submitted upfront. We track every authorization status and follow up aggressively to meet procedure timelines.

4. Specialty-Focused Authorization Expertise

Whether you’re a cardiologist, oncologist, or OB/GYN specialist, MBW tailors its prior authorization process based on your specialty’s coding patterns and payer rules. This specialization helps reduce denials related to medical necessity and improves overall RCM efficiency.

5. Technology-Enabled Pre-Visit Workflow Automation

We incorporate robotic process automation (RPA) and AI tools to verify benefits, validate referrals, and even flag pre-certification issues. This reduces manual effort, shortens turnaround times, and increases throughput, especially in hospital and urgent care environments.

6. Real Results: Case Studies That Prove the ROI

One of our multi-specialty clients saw a 40% reduction in prior auth denials within 60 days of onboarding. In another case, eligibility errors dropped to under 2% — all thanks to MBW’s proactive patient access protocols. These real-world improvements reflect our commitment to measurable impact.

Improving patient access with robust insurance verification and prior authorization services isn’t just about administrative accuracy — it’s about protecting revenue and delivering a better patient experience. MBW RCM helps healthcare providers take control of this critical first step in the revenue cycle.

Discover how our full suite of Patient Access Services can support your revenue goals. Or connect with us to learn more about specialty-specific RCM solutions tailored to your practice.