Medical billing is the process of submitting claims to insurance companies or patients for reimbursement of medical services, involving coding, claim generation, and following up on payments to ensure healthcare providers get paid.
CPT codes are classified into 3 categories: I) Category I – This is the main category of CPT that used by providers to represent their different services and reimburse the payment. Below are the 6 different sections of this category with specialties and CPT range, 1. Anesthesia Services: 00100 – 01999 & 99100 – 991502. Surgery: 10004 – 699903. Radiology … Read more
The Health Insurance Portability and Accountability Act (HIPAA) is a cornerstone of the U.S. healthcare system, ensuring the privacy, security, and efficiency of patient data. Enacted in 1996, HIPAA has far-reaching implications for healthcare providers, payers, and patients alike. This article delves into the importance of HIPAA, the key processes involved in medical billing, the … Read more
What is Denial Code CO 27? Denial Code 27 in medical billing refers to “Expenses incurred after coverage terminated”. This means that the claim was denied because the services were provided after the patient’s insurance coverage had expired or was no longer active. Common Causes of Denial Code 27 How to Fix Denial Code CO … Read more
What is Denial Code 22? Denial Code 22 in medical billing refers to “This care may be covered by another payer per coordination of benefits (COB).” This denial occurs when the insurance payer determines that another insurer should be the primary payer, leading to claim rejection or a delay in reimbursement. Common Causes of Denial … Read more
What is Denial Code 29? Denial Code 29 in medical billing indicates “The time limit for filing has expired.” This means that the claim was submitted after the payer’s allowable timeframe for claim submission, resulting in denial. Every insurance payer, including Medicare, Medicaid, and commercial insurers, has a specific timeframe within which claims must be … Read more
Understanding Denial Code 7 (CO-7): Procedure Inconsistent with Patient’s Gender In medical billing, Denial Code 7, also known as CO-7, means that the procedure or revenue code submitted on a claim is inconsistent with the patient’s gender as listed in their records. This can lead to a claim denial from insurance payers, including Medicare and … Read more
In health insurance, individuals can choose from different plans based on their needs. Three common types are HMO, PPO, and POS. These plans offer healthcare coverage. However, they vary in structure, flexibility, cost, and access to services. Here’s a breakdown of each: 1. Health Maintenance Organization (HMO) An HMO, or Health Maintenance Organization, is a … Read more
Primary Care Physicians (PCPs) and Specialists play distinct but complementary roles in the healthcare system. Understanding the differences between them, their responsibilities, and the steps involved in their workflows can help patients navigate the healthcare system more effectively. Primary Care Physician (PCP) Role and Responsibilities: Steps in PCP Workflow: Specialist Role and Responsibilities: Steps in … Read more
