Managing out-of-network denials refers to the process of addressing and resolving claims that are rejected by insurance providers due to the healthcare service being rendered by a provider who is not part of the insurance network. This can result in the patient being responsible for paying a larger portion of the bill or the entire cost of the service. Effective management of out-of-network denials involves understanding the reason for the denial, appealing the decision, and exploring alternative payment options to minimize the financial impact on the patient.Read More
The “code first” note is your hint that two codes may be needed, along with sequencing direction. The “code first” note is an instructional note.
If you see “in diseases classified elsewhere” terminology you will assign two codes, with the manifestation code being sequenced after the underlying condition. The “in diseases classified elsewhere” (manifestation) code is actually part of the code title. The code with “in diseases classified elsewhere” documented can never be used as a principal diagnosis.Read More
There can be confusion on how to report lateral- LT/RT and bilateral modifiers-50.
Coders report many of these incorrect or miss reporting altogether.Read More
There is a false impression that medical coders sit in their pajamas all day while entering codes consisting of letters and numbers.
Here is what a coder’s job truly consists of!Read More
What is the difference? We'll tell you!
When looking for a job in the medical coding world, there is often some confusion between facility coding and professional coding. The main difference is that professional coding is mandated by CMS and facility coding is facility based. In this article, we are going to focus on the difference in the emergency room setting.Read More
Can a medical coder fulfill the role of an inpatient CDI? Yes, a seasoned, credentialed coder can.
A seasoned, credentialed coder has the skills necessary to see the story of a patient. These high-level coders investigate, analyze and problem solve. These are not just people who apply codes- they take ownership of the record.Read More