Revenue Cycle Management

Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC The American Medical Association (AMA) added a Telemedicine Services category to the Evaluation and Management (E/M) section of the Current Procedural Terminology (CPT) code set. Codes are divided up by the technology used and the patient type (ie, new vs. established). These codes are for synchronous, real-time interactive encounters between the provider and the patient. Codes are leveled by medical decision making (MDM) or time, which is similar to the office visit codes. CPTTechnologyPatient TypeMDMTime Minimum98000Audio-videoNewStraightforward15 minutes98001Audio-videoNewLow30 minutes98002Audio-videoNewModerate45 minutes98003Audio-videoNewHigh60 minutes98004Audio-videoEstablishedStraightforward10 minutes98005Audio-videoEstablishedLow20 minutes98006Audio-videoEstablishedModerate30 minutes98007Audio-videoEstablishedHigh40 …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC Three elements determine the level for evaluation and management coding (E/M). “Amount and/or Complexity of Data to be Reviewed and Analyzed” is 1 of them and also the most confusing. Data Reviewed remained a point system after guidelines changed in 2021. As an auditor, I see both undercoding and overcoding in E/M caused by not applying the rules correctly. Let’s start with what tests count toward Data Reviewed. Lab tests—whether performed in-house or sent out to a laboratory—always count toward Data Reviewed. Labs …
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We are deep into the fourth quarter of 2024, and you are probably preparing for the holidays and wrapping up year-end projects. As we celebrate the end of the year, it is important to also look ahead and lay the groundwork for revenue cycle management success in 2025. Following are some points to consider in your strategic plan for next year. Contract Renegotiations Understanding your payer agreements and your patient population will be instrumental to successful contract renegotiations in 2025. Once your agreement has met its initial term, you can …
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Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC We are heading into fall, and fall starts with updates to the ICD-10-CM codes. The most recent changes went into effect on October 1, 2024. There is no grace period. Because ICD-10-CM codes are date-specific, claims prior to date of service October 1, 2024, need to use the codes for that time period, switching over to the update on the exact day. While ICD-10-CM codes are updated semi-annually, the major updates occur in October. Changes include 252 new codes, 36 code deletions, and …
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Over the past 2 decades, urgent care has been on the forefront of consumerism. Increasingly, healthcare consumers are realizing how much they are contributing to the cost of healthcare delivery through taxes and payroll premium deductions, and therefore, they’re more motivated than ever to attain the full value of the benefits they’ve paid for. Urgent care has remained focused on the consumers’ sense of value by appealing directly to patients as clinics market their convenient locations, diagnostic capabilities, and extended night/weekend hours. However, regardless of their reasons for preferring an …
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