Power of Cloud Computing in Healthcare: Applications, Benefits, and Future Trends

Cloud computing is transforming healthcare with its tremendous benefits of accessing and storing data and applications online instead of on physical servers. It addresses healthcare’s biggest issues, including scalability, cost-efficiency, data security, and collaboration.

Cloud infrastructure’s scalability lets healthcare providers grow without investing in hardware or IT. Cloud-based applications improve patient outcomes, workflows, and healthcare decision-making.

Today’s post is all about cloud computing in healthcare. It discusses cloud computing’s applications, benefits, and future trends. It also highlights cloud security in healthcare. So, let’s explore how it has been innovating healthcare delivery and improving patient care.

Cloud Computing in Healthcare

Cloud computing in healthcare stores, manages, and processes data and applications on remote servers and networks via the Internet. Healthcare professionals use it to store and access patient data and interact with other providers.

Benefits of Healthcare Cloud Computing

Some of the benefits of cloud computing in healthcare are listed below:

Flexibility: Cloud computing allows healthcare businesses to expand resources according to demand. Scalability lets healthcare providers handle changes in data storage, system performance, and user access without adding physical infrastructure.

Cost-saving: Healthcare firms can save money and improve efficiency by switching to cloud-based services. Cloud-based solutions automate administrative procedures and boost operational efficiency.

Data security and privacy: Cloud service providers follow strict security protocols. Cloud platforms protect patient data with robust encryption, access controls, and data backup.

Collaboration: Cloud computing in healthcare provides real-time access to patient records, test results, and treatment plans on any device. Healthcare practitioners can securely communicate information, exchange expertise, and consult with specialists to improve care coordination, decision-making, and patient outcomes.

Applications of Healthcare Cloud Computing

The following are the main applications of cloud computing in healthcare:

EHR: Cloud computing makes EHR management easier by reducing the need for on-site servers and hardware. Cloud-based EHR solutions efficiently store, backup, and retrieve patient data for authorized healthcare practitioners. Providers can analyze patient data, update records, and cooperate regardless of location, improving care coordination. Patients can also access their EHRs to participate in their healthcare.

Telemedicine: Telemedicine is possible using cloud-based infrastructure, allowing patients to get virtual consultations, diagnostics, and treatment from home. In the cloud, real-time audio and video communication between patients and healthcare providers speeds up care and reduces in-person visits. Healthcare practitioners can get real-time alerts, determine early warning signals, and respond swiftly, improving chronic disease management and patient outcomes.

Big Data and AI: Big data analytics requires scalable and powerful cloud storage and computing infrastructure. Cloud resources allow healthcare professionals to analyze massive amounts of information, find trends, and make data-driven decisions to improve patient care and population health management. Cloud computing aids AI algorithms and machine learning model development to evaluate medical pictures, forecast patient outcomes, and enable individualized treatment strategies.

Healthcare Cloud Computing: Challenges and Considerations

Cloud computing offers many benefits to the healthcare industry, but it must be implemented and used properly. The following challenges are associated with cloud computing in healthcare:

  • Data Breaches

Storing patient data in the cloud poses data breach risks. Healthcare firms must use encryption, access controls, and regular security assessments to safeguard patient data from cyberattacks. Moreover, healthcare providers must follow HIPAA requirements to preserve patient privacy and data confidentiality. Cloud providers must comply with these regulations to secure patient data.

  • Integration Issues

Integrating cloud-based platforms and traditional systems is difficult. Interoperability standards and protocols are needed to securely and efficiently share patient data across systems and providers. Similarly, moving data to cloud systems involves careful preparation and execution. Healthcare businesses must evaluate data portability, integrity, and cloud provider transfers.

  • Regulations

Healthcare businesses should carefully assess cloud service providers for compliance with industry legislation and security standards. Choose a supplier with strong security, data encryption, and data backup and recovery. Additionally, healthcare firms must evaluate where their cloud data is housed. Regional data protection legislation may necessitate keeping patient data within certain geographic bounds.

Several issues and factors must be addressed to protect patient data and ensure cloud security in healthcare. Healthcare businesses should work with cloud service providers and IT specialists to build robust security measures, data governance policies, and compliance with relevant regulations.

Healthcare Cloud Computing: Future Trends and Implications

Cloud computing in healthcare is growing, and future trends and implications will affect healthcare delivery and patient outcomes. These trends include:

  • Edge computing and IoT

Processing data at the network edge, closer to data generation, has great potential in healthcare. Edge computing minimizes latency and provides real-time analytics for remote patient monitoring, wearables, and telemedicine. Cloud computing and edge devices can fuel tailored and quick healthcare.

Similarly, connected medical devices and wearables create massive volumes of data. Cloud computing scales and computes this data. Cloud computing and IoT devices provide remote monitoring, real-time data processing, and preventive healthcare.

  • Patient Engagement and Personalized Medicine

Cloud computing allows patients and healthcare professionals to communicate health information seamlessly. Cloud-based portals and mobile apps let patients view their medical records, make appointments, and connect with their doctors. Cloud platforms enable patient education, remote consultations, and personalized health advice.

Cloud computing’s ability to store and analyze vast healthcare data helps tailored medicine. Healthcare providers can customize treatment programs, forecast illness risks, and optimize medications using big data analytics and AI algorithms. Cloud-based precision medicine platforms integrate genetic, clinical, and real-time patient data to improve diagnosis and treatment.

  • Data Governance

As cloud computing and data analytics advance, patient data ethics become crucial. Healthcare organizations must follow ethical and privacy norms to ensure patient autonomy and confidentiality. Data analysis should balance patient privacy concerns with transparent data governance structures and robust data anonymization.

AI algorithms in cloud computing raise concerns about bias and fairness in decision-making. To prevent healthcare inequities and ensure fair treatment, healthcare companies must address algorithmic bias. AI systems must be monitored, validated, and transparent to reduce biases and retain patient trust.

Cloud computing will revolutionize healthcare. Healthcare businesses may improve patient care, outcomes, and research using edge computing, IoT integration, personalized medicine, and ethical data practices.

See Also: Augmented and Virtual Reality (AR and VR) in Healthcare


Cloud computing has transformed healthcare delivery, management, and improvement. Healthcare professionals depend on its scalability, cost-efficiency, data security, and collaboration. Cloud computing in healthcare efficiently stores and retrieves electronic health records (EHRs) and improves information interchange, care coordination, and patient engagement.

Cloud computing has many benefits; however, data security, privacy, interoperability, and regulatory compliance must be addressed. Implementation of strong security, interoperability standards, and industry laws is crucial to protect patient data. Healthcare businesses will need ethical concerns and data governance to use patient data and develop unbiased AI algorithms responsibly.

All in all, cloud computing can revolutionize healthcare. Cloud-based technologies increase patient care, innovation, and health outcomes. Cloud computing will provide tailored, data-driven healthcare for all as technology evolves.

New Cpt Codes 2023: Is Your Practice Ready?

new cpt codes for 2023

CPT codes define the medical, surgical, and diagnostic operations physicians and other health care providers perform. CPT codes are essential for the uniformity of the medical billing process, and insurance companies require them. The American Medical Association (AMA) modifies the CPT code set during its annual meeting. For 2023, a few new codes and minor modifications to both new and old codes and descriptors were noted. Are you aware of the new CPT codes for 2023? If not, then no need to worry as we present to you all the new guidelines related to medical billing for the year 2023.

The CPT code set that is utilized in 2023 has undergone 393 editorial changes. Ninety-three code revisions, 225 new codes added, and 75 deleted codes. More than 40% of the code changes concern new technology services in Category III CPT codes and the expansion of Proprietary Laboratory Analyses (PLA) codes. Also, some code modifications affect how the COVID-19 vaccine is reported, tracked, and administered.

In the following sections of this post, we will discuss the new CPT codes for 2023. It will prepare you for the medical billing procedure.

Enlisting the New CPT Codes For 2023

Below is the list of new CPT codes for 2023 that will help your practice in the medical billing process:

1. Therapeutic Remote Monitoring

There are currently five new CPT codes for 2023 regarding remote therapeutic monitoring. The following are the new CPT codes for 2023:

  • 98975
  • 98976
  • 98977
  • 98980
  • 98981

These new medical billing codes expand on codes for remote physiologic monitoring introduced in 2020. The previous codes were: 99453, 99454, 99457, and 99988.

2. Taxonomy

Appendix R’s Digital Medicine – Services Taxonomy has new CPT codes for 2023 compatible with the following digital medicine services.

  • Clinician-to-patient care
  • Clinician-to-clinician (consultation) services
  • Services devoted to monitoring a patient
  • Services for digital diagnostics

The new medical billing codes for taxonomy services necessitate that synchronous services provide two-way, real-time communication between the parties. It must be accomplished through audio and video. Telephoning, using a patient portal, and sending encrypted emails are all options to communicate with someone when you are not physically present.

3. Primary Care Management

Four new CPT codes for 2023 for care management are:

  • 99490
  • 99491
  • 99439
  • 99487

These new medical billing codes are created for certified medical providers to report care management services for patients with a single chronic disease. Previously, a variety of chronic conditions qualified for reimbursement for these services.

4. Drug-releasing Implants

The new code 68841 is used to describe the eye-related drug-eluting implant operation. The new CPT code for 2023, i.e., 68841, indicates the insertion of a drug-eluting implant into the lacrimal canaliculus. The implant includes punctual dilation. This new medical billing code replaces code 0356T in Category III. The code 68841 is billed for a corticosteroid insert into the canaliculus. It is done to deliver dexamethasone to treat pain and inflammation after eye surgery.

Revised CPT Codes for 2023

The following CPT codes have been revised for the year 2023.

  • Code 99211

The CPT code 99211 was revised by eliminating the following: “Usually, the presenting problem(s) are minimal.” Instead, a new phrase has been added: “Office or other outpatient visits for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional.”

The code 99201 was eliminated in 2021 since it was rarely used.

  • Code 92065

The CPT code 92065 describes orthoptic training, also known as vision therapy. It is crucial to double-check the benefit plan descriptions, as some policies do not cover vision therapy.

  • Codes 67141 & 67145

These two codes for retinal detachment were modified in the section on prevention. In the proposed rule for 2023, the codes were modified to exclude the wording “1 or more sessions.” It allowed the services to be billed as a 10-day procedure instead of the current 90-day operation.

The following modifications have been made to the codes for retinal detachment:

Code Removed Revised
67141 1 or more sessions “Prophylaxis or retinal detachment (e.g., retinal break, lattice degeneration) without drainage, cryotherapy, diathermy.”
67145 1 or more sessions

laser or xenon arc

“Prophylaxis of retinal detachment (e.g., retinal break, lattice degeneration) without drainage; photocoagulation”


88342 CPT Code and Guidelines for 2023

The CPT codes for surgical pathology are structured such that the first code (CPT 88341), CPT 88342, corresponds to a single antibody stain procedure, and each subsequent code corresponds to an additional single antibody stain procedure.

The plus sign next to CPT 88341 indicates that it is an add-on code that can be billed only in conjunction with the 88342 CPT code.

Code Description
88341 Immunohistochemistry or Immunocytochemistry, per specimen; each additional single antibody stain procedure
88342 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure
88344 Immunohistochemistry or Immunocytochemistry, per specimen; each multiplex antibody stain procedure


It is not permissible to utilize more than one unit of CPT 88341, 88342, or 88344 per specimen for each antibody.

  • CPT 88341, CPT 88342, or CPT 88344 should not be reported with CPT 88360 or CPT 88361 if each procedure involves a different antibody.
  • When multiple antibodies that may be distinguished are used on the same material, one unit of CPT 88344 is used. It is known as “multiplex antibody staining.”
  • When multiple antibodies that cannot be found individually are placed on the same slide, CPT 88342 should be used. CPT 88344 should be utilized if an additional antibody that can be purchased separately is also used.

After implementing these new regulations, pathologists and laboratories must specify whether a multiplex or cocktail stain technique was employed.

  • The terms “single antibody stain procedure” and “multiplex antibody stain procedure” will have an impact on both the units of service and the code(s) selected. Staining antibodies is a component of both of these procedures.
  • The term “single stain process” indicates that the code for the “multiplex stain method” must be assigned to the same stain, which may comprise multiple distinct antibodies.

The procedure likewise determines the unit of service for the in-question multiplex stain. If all antibodies are stained using the same method, only one service unit is required for the multiplex stain. It is crucial to note that the 88342 CPT code requires billing a modifier 59.

See Also: New ICD 10 Codes for Pathology Billing – Is Your Practice Ready?


Coding is one of the most difficult aspects of running a practice because it directly impacts the revenue cycle and the bottom line. Precision Hub helps reduce the stress associated with coding by ensuring that your claims are processed accurately from the outset. Our team of experts is up-to-date with the new rules and regulations regarding the new CPT codes for 2023. So, contact Precision Hub immediately if you have any queries concerning the professional coding assistance we offer. Schedule your demo now and learn how we can boost your earnings by optimizing your coding procedures.

Physical Therapy CPT Codes & Billing Guidelines 2022

physical therapy cpt codes

Physical therapy is one of the services that can improve a patient’s health through physical activity and muscle movement.

A physical therapist will use physical therapy CPT codes to describe the services they provide to assist patients in regaining and maintaining their health. For instance, 97140 is used as a manual therapy CPT code. CPT 97014 is used to indicate the performance of modality therapy.

Practitioners must use the correct physical therapy CPT codes to reimburse the service. Regarding payment for medical or health services, the CPT codes used for physical therapy evaluations may differ from those used during home visits. The reason is that home-visiting therapists cannot provide a comprehensive range of services.

The present article contains information and a discussion of these coding principles. So, continue reading to learn important guiding principles related to physical therapy CPT codes.

Physical Therapy CPT Codes: Evaluation

Physical therapy evaluation is a dynamic procedure denoted by physical therapy CPT codes. The process assists physical therapists in making treatment decisions based on clinical data gathered during treatment. In this iterative process, the physical therapist uses the information gathered during the examination to make clinical decisions. Evaluation includes taking a thorough medical history, conducting a system review, and directing tests and measurements.

Then, a physical therapist will review the exam results, make a physical therapy diagnosis, determine the prognosis, and create a comprehensive care plan.

The following paragraphs will discuss how to code a physical therapy evaluation.

Physical therapy evaluation outcomes may be reported using the following physical therapy CPT codes:

  • 97161
  • 97162
  • 97163
  • 97164
  • 97140

A different set of codes is used for a home visit. Reporting the CPT G0151, CPT G0157, and CPT G0158 codes for home physical therapy evaluations ensures proper and accurate evaluations.

There are three forms of physical therapy evaluation, each with a distinct complexity level: low, moderate, and high. After determining the severity of the patient’s condition at any given time, several evaluation levels are performed.

The following physical therapy CPT codes are used to report on the various levels of evaluations:

CPT Code Description Complexity Ratio Time Duration Evaluation Procedure
97161 Physical therapy evaluation code that can be reported for minimal therapeutic complexity Low 20 minutes Evaluation with the patient’s family face-to-face (due to low complexity)
97162 Evaluation code for physical therapy that can be submitted for moderate therapeutic complexity Low 30 minutes Evaluation with the patient’s family face-to-face (due to moderate complexity)


97163 Evaluation code for physical therapy that can be submitted for high therapeutic complexity High 45 minutes Face-to-face evaluation
97164 Physical therapy re-evaluation 20 minutes Face-to-face evaluation

Physical Therapy CPT Codes: Home Visits

There are three CPT codes for reporting home health physical therapy when a therapist travels to multiple locations to provide therapy services.

  1. CPT G0157 is for use by assistant therapists
  2. CPT G0159 is for establishing a therapy plan for hospice/home care
  3. CPT G0151 is for use by physical therapists

With the CPT code 97014 for physical therapy, the therapist can demonstrate the use of modalities and electrical stimulation in one or more locations. Stimulation would alleviate the discomfort and swelling while accelerating the healing process.

The type of electrical stimulation utilized will depend on the patient’s condition and the physician’s diagnosis. Since constant monitoring of the stimulation treatment is required, a physician can only record one stimulation process each day. On the other hand, non-physical stimulation treatments can be administered and reported on the same day.

Modifier for Physical Therapy CPT Code

A modifier 76 will be applied to the manual therapy CPT Code, i.e., 97140, if more services than stimulation are provided on the same day or day of services. Each of the service codes for the additional services can be recorded separately. It will display the number of non-electrical stimulation services performed on the same date.

Physical Therapy CPT Codes for Pelvic Floor

Physical therapy can be utilized to restore pelvic floor function. When physical therapy treats pelvic floor dysfunction, either CPT 90912 or CPT 90913 may be reported. The supporting documents must comprehensively describe the service, such as “exercise or therapy for the pelvic muscles.”

Physical Therapy CPT Codes for Different Treatments

The below table illustrates CPT codes billed for different therapeutic approaches:

Codes Explanation
97110 Therapeutic Exercise: Includes strengthening, ROM, endurance, and flexibility exercises
97112 Activities that retrain movement, balance, posture, coordination, and proprioception/kinesthetic sensibility
97116 Gait training includes sequencing, modified weight-bearing, and appropriate turns
97140 Manual therapy includes soft tissue mobilization, joint mobilization, muscular energy techniques, and manual lymphatic drainage
97530 “Dynamic activities” to improve function. Sit-to-stand training, bed mobility, step-ups/stair negotiating, hip-hinge training, squatting mechanics, tossing a ball, swinging a bat or golf club, automobile transfer training, and good lifting mechanics
97535 elf-Care/Home Management Training comprises ADL training, compensating training, safety procedures/instructions, food preparation, and assistive technology/adaptive equipment use


97112 CPT Code

CPT 97112 is among the most important physical therapy CPT codes. Neuromuscular re-education is a condition that can be coded with the 97112 CPT code for physical therapy. Neuromuscular re-education improves function and reduces the severity of impairments. Therefore, using these strategies will likely improve the difficulties and problem regions.

Exercise can enhance the connection between your brain and the muscles that contract in response to anxiety. The senses determine how much effort it takes to move the body and where the various bodily components are concerning one another. Treatments can be tailored to specific claims; just as therapeutic activities can be tailored to certain bodily regions.

CPT 97112 can treat stroke patients and those with neuromuscular transmission problems or muscle ailments. Outside-the-hospital orthopedic rehabilitation procedures can be reported using this code. The record must include specifics concerning the executed activities or exercises, such as what was anticipated to occur.

The permitted time for the reimbursement of the therapy is 15 minutes. According to CMS regulations, each patient must have an eight-minute direct connection with a single service unit.

The patient and a medical professional, such as a therapist, must communicate directly for this treatment to be effective. If the procedure goes longer than the permitted time, a 15-minute CPT code can be generated.

When neuromuscular re-education (CPT code 97112), massage (CPT code 97124), and joint mobilization (manual therapy CPT code 97140) are performed in addition to chiropractic care, modifier 59 must be applied.

See Also: New ICD 10 Codes for Pathology Billing – Is Your Practice Ready?


Physical therapy CPT codes provide payers with consistent information about the services and procedures they cover. The practice’s financial health depends upon its ability to submit clean and accurate claims using the correct CPT codes for billing. It is wise to hire an expert medical billing and coding firm, i.e., Precision Hub, to file your claims on time and expedite the reimbursement process. Our tried-and-true method employed by our skilled medical coders and billers guarantee accurate coding and timely payments. It expedites the entire procedure, so medical facilities receive the money quickly.

Contact us for efficient medical coding and billing services without wasting further time. Call us now: (888) 454-4325.

New ICD 10 Codes for Pathology Billing – Is Your Practice Ready?

pathology billing

ICD-10-CM codes are the most critical evidence that the services your practice provides are medically necessary, so it is crucial to know them. Your reimbursement request will be denied if you cannot provide evidence that the treatment was medically necessary. Hence, you will have to pay for it.

Being familiar with the new ICD 10 codes for pathology billing is essential.

This post sheds light on different aspects of pathology coding and billing codes.

Pathology Billing

On July 7, the Centers for Medicare & Medicaid Services (CMS) released a proposed Medicare Physician Fee Schedule for 2023. The purpose of these modifications is to ensure that next year’s compensation for the technical aspect of pathology is more precise. Between 2022 and 2023, they wish to reduce payments for pathology by approximately 1%. There will be a reduction in the conversion factor by 4.4% to compensate for eliminating the 3% fee increase for 2022.

Pathology processes include the evaluation of blood, bodily fluid, or tissue samples taken from a patient and utilized to advise the treating physician. Typically, lab staff is responsible for preparing pathology and lab specimens and screening and testing them. However, it is the pathologist’s responsibility to ensure that lab results are accurate. The pathologist will examine or determine the significance of specific materials and tests. Such examples are blood and urine samples. For pathology billing, a pathologist can record the correct code from the E&M part of the CPT Manual if they meet CMS and AMA E&M guidelines and perform meaningful, individually identifiable face-to-face patient care services.

In 2023, there will be 78,496 ICD-10-PCS codes in use. It includes 331 new codes and the removal of 64 codes. Due to these changes’ impact on reimbursement, medical billing and coding services providers will need to get familiar with the new regulations.

According to the College of American Pathologists, thirteen (13) new CPT codes for digital pathology in Category III will be implemented on January 1, 2023. The CPT category III codes are a collection of temporary codes that can be used to collect data regarding services and procedures.

As per the new guidelines for pathology coding, codes 0751T through 0763T will be utilized to describe what clinical personnel performs when digitizing glass slides for the first diagnosis.

By digitizing glass microscope slides, a pathologist can do an examination remotely, alone, or with the assistance of artificial intelligence (AI) techniques. The Category III add-on pathology billing codes 0751T-0763T may be reported in addition to the right Category I service code when digitizing glass microscope slides and reporting the Category I code for the primary service. These add-on codes can be reported alongside the Category I service code.

Suppose a code from Category III is available. In that case, it should be reported in place of an unlisted code from Category I. Using Category III codes. Physicians, other qualified healthcare professionals, and insurers can identify services and procedures for clinical effectiveness, utilization, and results.

The new digital pathology add-on codes are related to CPT 88305, and 12 other commonly reimbursed pathology procedures (Level IV-Tissue Exam). Only cases in which the newly introduced add-on codes were used for clinical diagnosis should be reported.

The below table shows important codes related to pathology, digitization of glass microscope slides, and microscopic and gross examinations:

Codes Level or Groups Usage in Conjunction with
+0751T Level II


Separately with the primary procedure code


With 88302

+0752T Level III


Separately with the primary procedure code


With 88304

+0753T Level IV


Separately with the primary procedure code


With 88305

+0754T Level V Separately with the primary procedure code


With 88307

+0755T Level VI


Separately with the primary procedure code


With 88309

+0756T Group I Separately with the primary procedure code


With 88312

+0757T Group II Separately with the primary procedure code


With 88313

+0758T Histochemical stain on frozen tissue block Separately with the primary procedure code


With 88314

+0759T Group III Separately with the primary procedure code


With 88319

+0760T Immunocytochemistry or immunohistochemistry Separately with the primary procedure code


With 88342

+0761T Immunocytochemistry or immunohistochemistry per specimen Separately with the primary procedure code


With 88341

+0762T Multiplex antibody stain procedure Separately with the primary procedure code


With 88344

+0763T Single antibody stain procedure Separately with the primary procedure code


With 88360

Pathology Coding

More than 1,400 new diagnostic codes are added to the ICD-10-CM codes for 2023. All payers must be provided with the new mandatory codes. Since these codes suggest the necessity of seeking medical treatment, inappropriate use of the codes may result in claim denial and loss of reimbursement for services rendered.

Here are important highlights of the new pathology billing codes:

  • Expansion of the OB/GYN code (over 400 new codes)
  • Code for concussions and other brain injuries as well as dementia (over 100 new codes)
  • Code for methamphetamine overdoses, indicating new Category for meth poisoning
  • Codes for electric bike injury, allowing for additional information about the accident

In addition to the above-described code extensions, the following specialty and conditions will be coded significantly differently:

Code Series Description
I25.- Atherosclerosis
F10.9 Alcohol and other substance use
C84.4 T-cell lymphoma
G71.03 Limb-girdle muscular dystrophy
B37 Candidiasis (vulva and vagina)
E87.2 Acidosis
D68.0 Von Willebrand disease
M93.0 Slipped upper femoral epiphysis
E34.3 Short stature
M62.5A Back’s Muscle wasting
P28.- Newborn sleep disorders
D59.3 Hemolytic-uremic syndrome

Preparing for New ICD 10 Codes for Pathology Billing

Utilizing the appropriate diagnostic and procedure codes when submitting claims to insurance companies for pathology-related medical services is crucial. Outsourcing your pathology billing to Precision Hub is the best approach to fulfilling any new ICD coding regulations for pathology billing. We have years of experience in the business, allowing us to monitor all aspects of the pathology coding process and assist you in better managing your revenue cycle.

See Also: Preventive Medicine Services Coding Guidelines


There is no practice where coding does not significantly influence the revenue cycle and bottom line. With the assistance of Precision Hub’s coding services, you can rest assured that your claims will be processed correctly from the beginning.

Precision Hub provides ICD-10-compliant coding services to its customers as a medical billing and coding outsourcing leader. Our coders apply the ICD 10 Pathology Billing Codes that best depict the patient’s treatment. We provide you with the most recent medical codes for the services you provide to your patients per AMA and CMS regulations.

Schedule your meeting with us to learn more about our professional coding assistance.


Preventive Medicine Services Coding Guidelines

cpt preventive codes

Preventive care, designed to prevent problems can aid in detecting or preventing significant diseases and health problems before they become major issues. Examples of preventative care include annual checkups, vaccinations, flu injections, and participation in specific screenings and exams. This type of preventive care is also referred to as routine care.

In diagnostic care, a physician searches for a specific condition. For instance, a radiologist may recommend a patient for follow-up mammography. This follow-up will determine if anything was discovered during the normal or preventative mammography. After the initial screening for preventative treatment, diagnostic mammography is not covered by insurance.

Let’s learn more about the preventive medicine coding guidelines for 2022. The post details CPT preventive codes.

CPT Preventive Codes

Comprehensive preventive medicine services include counseling, anticipatory guidance, and risk factor reduction strategies. They are typically distinct from disease-related diagnoses and entail a patient-specific history and physical examination.

CPT preventive codes include 99381-99387 and 99391-99397.

  • 99381-99387: CPT preventive codes for the preventive exam of new patient
  • 99391-99397: Codes for the preventive exam of an established patient.

During a preventive visit, an unexpected item is discovered, an old problem is resolved, and essential E/M, i.e., Evaluation and Management services, are provided. It is known as “E/M service in a single visit.”

The diagnosis codes for the preventive coding include the following:

  • 00: General medical checkup of an adult with no abnormal findings
  • 01: General medical checkup of an adult with abnormal findings
  • 110-Z00.129: Newborn, infant, and child health checkups
  • 411: Gynecological checkup with abnormal results
  • 419: Gynecological checkup without abnormal results
  • 011-Z30.9: Contraception management

Use the corresponding Z code from the list alongside the CPT preventive code as the primary diagnosis code. The next step is to arrange by the time all of the short-term, long-term, and health status concerns that the physician discussed and recorded throughout the examination. In addition to the Z codes, documenting and coding any new or existing conditions present at the annual preventive exam will not result in claim denial.

Suppose a new abnormal discovery or an existing problem is significant enough during a preventive exam to necessitate additional work. In that case, the appropriate CPT preventive code from 99202-99215 with modifier 25 should also be reported. Modifier 25 indicates that the work was performed due to a current issue. In this instance, the documentation from the provider describing the new or old finding must be distinguishable from the documentation from the preventive exam. The member may be required to pay copayments or split the cost of insurance to receive these additional services. It is improper to submit a separate fee for prescription refills or medical conditions that do not require further work.

Preventive Medicine Coding Guidelines 2022

Below are the important guiding points for preventing medicine coding:

  • Doctors use measurements such as height, weight, body mass index, head circumference, and blood pressure as part of preventive medicine. Additionally, they conduct age- and gender-appropriate tests and histories.
  • Since CPT preventive codes are not time-based, the duration of the patient’s visit should not be considered while selecting the correct code.
  • Suppose an illness is discovered or any pre-existing problem is addressed during a preventive medicine service that requires additional work. In that case, the appropriate CPT preventive code (99202-99215) should be reported in addition to the preventive CPT codes. Add modifier 25 to any outpatient code (e.g., 99392 and 99213 25).
  • No separate report is required for any sickness, abnormality, or condition discovered during the preventive medicine service deemed minor.
  • Immunization materials and administration, as well as supplementary investigations requiring laboratory, radiological, or other procedures or screening tests (such as for eyesight, development, or hearing), are recorded and reimbursed separately from the preventive medicine service code.

Preventive Medicine Coding Guidelines and Abnormal Findings

When an ICD-10 code, such as Z00.121, is assigned to an abnormal finding, it does not indicate that an additional E/M service is necessary or even permitted. Even if abnormal findings are minor and do not necessitate additional examination, the condition may be documented as a contributing factor. Abnormal findings include abnormal screening results, new acute conditions, and deteriorating chronic illnesses. Stable chronic conditions do not require an abnormal results code, even if they are being treated. Even if the screening was normal, you could relate it to a code for abnormal findings under ICD-10. The incorrect item will be labeled with the correct ICD-10 code to alert the payer.

Modifier 25

Extra billable services comprise independent, significant physician evaluation and management (E/M) work. It is often performed as part of preventive medicine treatment or small surgical procedures. Modifier 25 informs the insurance company that payment is required for both procedures. When utilized properly, it can generate more revenue.

Modifier-25 indicates that the assessment and management service was significant and distinguishable from a small procedure performed on the same day. If you apply modifier 25, you may be able to receive payment on the same day for both the preventative visit and the problem-oriented E/M service or procedural service. Including a modifier 25 regarding the second service reduces the likelihood of incorrect bundling or denial.

See Also: Know your DME HCPCS Codes


The CPT preventive codes 99381–99397 report newborn, child, adolescent, and adult preventative evaluation and management (E/M). These codes are billed alongside the ICD 10 codes. A modifier 25 is often billed with these codes in case additional service is billed. You can increase your likelihood of receiving the correct insurance reimbursements by reviewing the payer’s coding guidelines and reimbursement criteria. Alternatively, you can outsource these complex tasks to professionals like Precision Hub for improved cash flow.

Precision Hub is a leading organization that assists the medical industry with its billing and coding requirements. We assist you with medical billing and coding for your practice. So, schedule your meeting with our expert manager to sort out your medical billing or coding issues.

Know your DME HCPCS Codes

hcpcs codes for wheelchairs

For claims to be paid, selecting the correct code of the Healthcare Common Procedure Coding System (HCPCS) is crucial. Using the valid HCPCS code when processing claims ensures that the claim is reviewed accurately and that the correct reimbursement amount is granted. Conversely, incorrect coding could result in improper payments that must be recouped and could lead to false claim actions. Therefore, all sellers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) must take the appropriate measures to ensure claims are appropriately coded.

An essential component of medical care is using DME, including a wheelchair. Knowing HCPCS codes for wheelchairs is crucial for timely reimbursement. We enlist HCPCS codes for wheelchairs and discuss DME coding in the present post. Moreover, the post also sheds light on the guidelines related to the CPT code for wheelchairs. So, keep reading to learn about DME HCPCS codes. 

HCPCS Codes for Wheelchairs

The Healthcare Common Procedure Coding System, or HCPCS, is a standard set of codes used to bill for services by all payers, including Medicare and Medicaid. The HCPCS is subdivided into two principal subsystems, levels I and II. Current Procedural Terminology (CPT), i.e., numerical coding scheme comprises Level I of the HCPCS. CPT’s primary objective is to catalog the medical treatments, dental services, and procedures provided by physicians and other health care providers. The HCPCS Level II is a standardized coding system used primarily to identify products, suppliers, and services not covered by CPT codes. This is when ambulance services and DMEPOS, including wheelchairs, are utilized outside a physician’s office. Medicare and other insurance companies cover treatments, supplies, and equipment not expressly identified by CPT codes. 

Medicare and other health insurance companies are required to utilize the E1130-E1161 code set to process healthcare claims.

Description of HCPCS Codes for Wheelchairs

Here is the range of HCPCS codes for wheelchairs: E1130-E1161.

HCPCS Code Description 
E1130 A standard wheelchair with fixed or swing-away detachable footrests, fixed full-length arms,
E1140 Wheelchair, desk or full length, detachable arms, swing away detachable footrests
E1150 Wheelchair, desk, or full-length swing away detachable elevating leg rests, detachable arms
E1160  Wheelchair, swing away detachable elevating leg rests, fixed full-length arms
E1161 Manual adult-size wheelchair includes tilt in space

Medicare and other health insurance companies require a set of standardized codes for wheelchairs, components, and accessories. This set of HCPCS codes for wheelchairs ranges from K0001 to K0195 to pay for health treatment. Some of these codes are listed below:

HCPCS Code Description 
K0001 Standard wheelchair
K0002 Standard Hemi (low seat) wheelchair
K0003 Lightweight wheelchair
K0004 High-strength, lightweight wheelchair
K0005 Ultralightweight wheelchair

DME Coding and Modifiers 

When it comes to medical billing for DME, your DME coders must be familiar with the correct HCPCS codes and modifiers, which provide additional information about the device. The insurance company may only accept the claims if your medical coders know how to utilize modifiers or apply them correctly. 

The common modifiers used in DME coding with HCPCS codes for wheelchairs are: 

  • RR represents renting equipment 
  • UE means buying used equipment
  • NU represents the purchase of new equipment

Many HCPCS codes for wheelchairs require the addition of a modifier before they may be used to indicate DME. When modifiers are applied, extra information can be provided about the DME item. It can suggest whether an item is brand-new or rented. For clarity, modifiers determine which month’s rent is billed for capped rentals.

Your claim will be denied if any of these modifiers are used incorrectly. You can expedite the processing of your claims by providing proof of the first month’s rent and billing your shares in the order they were received. The correct modifier code must be entered.

CPT Code for Wheelchair 

In addition to the HCPCS codes for wheelchairs, there is a CPT code also. It describes the evaluation and training processes for the use of the wheelchair.

CPT 97542 is used to describe the procedure of an evaluation to determine whether a patient requires a wheelchair. This may include the patient’s strength, location, weight, skin health, and other similar factors.

After determining the patient’s demands, the following step is to obtain measurements to acquire the appropriate equipment.

During determining how to fit the wheelchair into the patient, the patient’s abilities are evaluated, the patient’s mobility skills are assessed, and the patient is instructed on how to alter and operate the wheelchair.

Most examinations and fittings can be completed in one or two visits. If medically necessary, more sessions may be scheduled.

The wheelchair management CPT code 97542 includes training patients to do functional tasks that enhance safety and mobility.

People who use wheelchairs may occasionally require positioning assistance from a qualified specialist to minimize pressure sores, contractures, and other health issues.

The reimbursement for wheelchair coding includes all labor expenses involved with wheelchair assembly. The amount reimbursed may also include support services such as emergency services, wheelchair delivery, and setup and training.

Medical Necessity and CPT Code for Wheelchair

CPT 97542 is deemed medically necessary only when it requires the skills of a licensed therapist, is intended to fulfill specific patient needs, and is a part of an active treatment plan to attain a particular outcome. 

It is also important that the patient must have the ability to follow the instructions related to wheelchair use. A patient requires 3 to 4 sessions to master these skills. If medically necessary, more sessions may be scheduled.

See Also: Improving Coding for Diabetes with Hypertension Associated


Accurate claim processing requires the use of the correct HCPCS code. However, if the codes are entered incorrectly, it could lead to erroneous payments that need to be recovered and even fraudulent claim actions. As a result, every DMEPOS vendor must take the necessary steps to guarantee that claims are correctly coded. Wheelchairs and other DME play an important role in medical treatment. Sufficient knowledge of HCPCS codes for wheelchairs helps in timely payment. 

Claims must be appropriately coded to be paid correctly. Precision Hub provides clinicians with accurate and efficient medical billing and coding services. You can call us at (888) 454-4325 if you have questions about HCPCS codes for wheelchairs. You can also book your free demo to learn how we help physicians streamline their practice.

Improving Coding for Diabetes with Hypertension Associated

diabetes with hypertension icd 10

Most coders are unaware of the correct code for diabetes with hypertension(ICD-10). High blood pressure is not specifically labeled as a problem. Diabetes mellitus codes are letter-and-number combinations that describe the type of diabetes, the affected body system, and the complications associated with that system. These codes must represent all the difficulties related to the condition and be organized from categories E08-E13.

Diabetes with hypertension ICD-10 guidelines suggest entering code I10 if the patient has hypertension and code E11 if they have documented type 2 diabetic symptoms. ICD-10 does not assume a connection between hypertension and diabetes as with other illnesses. The two conditions must be reported individually, even if they share a common source.

The present article intends to shed light on all the important aspects related to the coding and billing for diabetes with hypertension using ICD-10. In this post, you will also learn about the ICD-10 code for hypertension. Continue reading this post to get familiar with the billing /coding rules for hypertension with diabetes ICD-10.

Diabetes with Hypertension ICD-10

Since diabetes and hypertension are related, it is essential to carefully analyze all documentation from providers and place it in the appropriate category. Evidence and support indicate that diabetes co-exists with hypertension. So, reviewing guidelines for coding and billing is crucial for diabetes with hypertension ICD-10. If the doctor had written “diabetes and high blood pressure,” you would not assume the two diseases are related. ICD-10 does not connect the terms “diabetes” and “hypertension” with the conjunction “with.”

If the physician has documented that diabetes is the direct cause of high blood pressure, then high blood pressure should be referred to as a circulatory impact. As complications, only the terms specified under “diabetes with” in the index should be included, and each of these terms should have its documentation.

When “with” or “in” appear in a code title, they should be interpreted as “connected to” or “because of.” This is true regardless of location. The classification presupposes a connection between the two items linked by these terms in the alphabetical index or tabular list. Even if not explicitly stated in the provider documentation, these circumstances should be coded as related unless the documentation states otherwise. If these relational phrases do not expressly link two criteria in the classification, or if a guideline states that two conditions must be explicitly linked, then the provider documentation must connect the requirements for them to be coded as related.

Unless the doctor draws a strong connection between the two, it is not believed that diabetes and hypertension are associated, so there is no particular code for diabetes with hypertension ICD-10. If a patient has both diabetes and retinopathy, the two illnesses are likely connected. It appears likely that there is a connection and that the correct combination code will be provided.

ICD-10 Diabetes codes are groupings of codes that identify the type of diabetes, the affected body component, and any associated problems.

Diabetes should be marked as E11.9, while hypertension should be coded as I10. Diabetes and hypertension are not always associated; therefore, we must carefully study and record the information the healthcare practitioner provides.

icd-10 code for hypertension

Diabetes with Hypertension ICD-10 Guidelines

To include hypertension as a complication of diabetes, code I15.2, “Hypertension related to endocrine disorders,” and E11.- for diabetes. In the doctor’s note, it must also be stated that diabetes is the reason for high blood pressure.

ICD-10CM posits a cause-and-effect relationship between chronic kidney disease (CKD), hypertension (HTN), and diabetes.

When all three diseases are present, the likelihood that CKD is associated with HTN or diabetes is significantly increased. Both high blood pressure and high blood sugar levels in the blood vessels can cause damage to the blood vessels, which in turn can cause damage to the kidneys.

If the documentation from the physician indicates that the chronic kidney disease is unrelated to hypertension, the CKD should not be identified as hypertensive. Based on the information provided, the following ICD-10-CM codes for the patient’s visit are reported:

  • E11.649 for type 2 diabetes mellitus
  • E11.22 for type 2 diabetes with diabetic CKD
  • I12.9 for hypertensive CKD

ICD-10 Code for Hypertension

Every medical center offers treatment for hypertension. The diagnostic codes have been simplified with the release of ICD-10, and the hypertension table is no longer required. Although controlled and uncontrolled blood pressure has no bearing on coding, effective clinical documentation should reflect the patient’s condition and the type of hypertension being treated.

Combination codes have been developed for reporting hypertension and its associated conditions.

Here are some of the categories of hypertension:

  • Hypertension (primary, benign, essential): I10
  • Hypertensive heart disease: I11
  • Hypertension & chronic kidney disease: I12
  • Hypertensive heart & CKD, i.e., Chronic Kidney Disease: I13

Category I11, i.e., hypertensive heart disease, is used when the documentation demonstrates or suggests a cause-and-effect relationship between hypertension and heart disease. A second code should be used to determine the kind of cardiac failure if the heart fails.

ICD-10 code for hypertension, i.e., I10, is a billable medical code used for reimbursement purposes. When I10 is the primary diagnosis, it is typically insufficient to justify hospitalization with acute care.

The following codes above I10 contain references to annotations that may be pertinent to I10:

  • Conditions affecting the cardiovascular system: I00-I99
  • Hypertensive disorders: I10-I16

The ICD-10 system assigns a single code to those who meet hypertension criteria but do not suffer from heart or kidney illness. This is known as I10, essential hypertension, or primary hypertension.

The primary cause of secondary hypertension is the underlying disease. Two codes must be entered: one from category I15 to determine what high blood pressure is and another from category I14 to determine what caused the high blood pressure. The purpose for entry or contact determines the order of the codes.

Category I13 is used for hypertension with diabetes in the ICD-10 system.

See Also: Guide to Medical Billing and Coding Best Practices


Diabetes and hypertension are two common illnesses that occur regularly. Diabetes with Hypertension ICD-10 guidelines indicates that E11.9 must be coded for type 2 diabetes mellitus without complications while I10 must be used for primary hypertension.

Precision Hub is a market-leading firm that assists the medical industry with its billing and coding requirements. You can review the payer’s coding instructions if you want to know how to code diabetes-related hypertension. If your practice requires medical billing and coding assistance, don’t hesitate to contact us through email at info@arturodigital.org or by phone at (888) 454-4325.

ICD-11: What it , when it is Coming, and How it Will Differ from ICD-10

When is ICD 11 coming out

The World Health Organization (WHO) released the eleventh version of the ICD 11 in June 2018. The new edition was written differently than the original. Reconstructing the coding system and digitizing the ICD were two of the most critical undertakings. In reconstructing the coding system, cluster coding was utilized. Therefore, alphanumeric codes could be used to define complex clinical circumstances more precisely. But the main query is: when is ICD 11 coming out?

In this post, we will answer this query. The article intends to answer when ICD 11 is coming out. The present post also compares ICD 10 vs. ICD 11, highlighting the difference between ICD 10 and ICD 11. So, continue reading if you wish to know when ICD 11 is coming.

When Is ICD 11 Coming Out

ICD 11 is the current international standard for the recording, reporting, analysis, interpretation, and comparison of death and illness rates. This eleventh version is the product of an unprecedented global effort by physicians, statisticians, category experts, and IT specialists. As a result, it is currently utilized by medical coders. ICD 11 employs an up-to-date and clinically useful classification system to assist countries in counting and identifying their most pressing health concerns. The ICD 11 assigns codes to diseases and conditions. Currently available are 17,000 diagnostic categories and over 100,000 medical diagnostic index phrases. For the first time, the ICD has been completely digitized. The search algorithm can comprehend more than 1,600,000 terms based on an index.

Compared to previous editions, ICD 11 represents a substantial improvement. It incorporates significant advancements in science and medicine, bringing disease classification up to speed with the most recent information on how to treat and prevent diseases. ICD 10 does not adequately capture the crucial clinical information that already exists. ICD 11 is renowned for making coding simpler and more precise, requiring less training than ever. The classification system is both online and offline, which increases its utility. Since it contains a new application programming interface (API), ICD 11 is now ready for usage in digital health. It includes a collection of online services that support many languages and have built-in usage instructions.

So, when is ICD 11 coming out?

The ICD-11 was created, received widespread acceptance, and was implemented on January 1, 2022. Nonetheless, implementing the system will require some time. The WHO estimates that it will take between one and two years for nations that have never used an earlier version of ICD or have only a basic information system to integrate it completely. People who work with more complex systems and have utilized previous versions of the ICD may require up to five years to completely incorporate the most recent version. Even though the official plan has yet to be finalized, it is anticipated to be fully implemented by 2025.

ICD 10 vs. ICD 11

ICD 10 vs. ICD 11

ICD-11 is superior to ICD-10 in numerous respects. ICD 10, for example, contains just eleven distinct disorder groupings, but ICD 11 contains twenty-one different disorder groups. ICD 11 has a more complicated structure than ICD 10, which is another way in which it is superior. The ICD 10 lacks a distinct classification for mental and behavioral disorders.

ICD 11 was created to address some of ICD 10’s most significant flaws. It provided the possibility to include the most recent medical findings, technological advancements, and changes in how doctors do their duties. ICD 11 features a new coding system, a method for identifying and grouping diseases and illnesses, that is simple to use and applicable worldwide.

It has been translated into 43 different languages, making it usable worldwide. This new version can be used as a universal coding language by researchers and healthcare professionals worldwide. It is an excellent way to facilitate comparisons between countries.

ICD 10 vs. ICD 11: User Friendliness

The ICD 11 was designed to be user-friendly and compatible with computers. It is easy to use and understand. It is also machine-readable, which is a benefit.

ICD 10 vs. ICD 11: Dimensional Approach

Adopting a dimensional method, often known as the dimensional approach, is an additional advantage of ICD 11 over ICD-10. As a result, any modifications, updates, or new information can be efficiently documented.

Difference Between ICD 10 and ICD 11

A major difference between ICD 10 and ICD 11 is that ICD 11 does not include a separate grouping for mental and behavioral disorders that manifest in childhood or adolescence. This is the primary difference between ICD 10 and ICD 11 regarding chapter organization. The ICD 11 has been modified to reflect the outcomes of international experts’ collaborative efforts and new knowledge regarding mental diseases. Numerous secondary clinical categories have been elevated in the hierarchy, resulting in the creation of additional subchapters. Many classes have been relocated to new subchapters. In light of contemporary epidemiology and the knowledge of the etiology of mental diseases, several ICD categories have been removed. Additionally, some previously nonexistent types have been introduced.

Diagnoses added to ICD 11 include:

  • Gaming Disorder
  • Attention Deficit Disorder
  • Complex PTSD
  • Compulsive Sexual Behavior Disorder
  • Prolonged Grief Disorder

Diagnoses removed from ICD 11 include:

  • Personality Disorder
  • Acute Stress Disorder
  • Gender Incongruence

Concerning ICD 11’s coming out, it is anticipated that governments are expected to begin preparing for the shift; however, there is no deadline by which it must occur. Each member state will adopt ICD 11 at its speed, based on its requirements and resources. Therefore, implementing the new version globally will take a lot of work.

See Also: Common ICD 10 Codes for Gastroenterology


The release of ICD 11 is an important event for the medical community as it will provide a more comprehensive and accurate system for classifying diseases and health conditions. The new version of the ICD will include updates to existing and new codes to reflect advances in medical knowledge and technology. ICD 11 was released in 2022, but regarding the main query, i.e., when is ICD 11 coming out, it is anticipated to be implemented in 2025. It will be available electronically and can be used by all Member States. Its implementation will be a gradual process and require the support of all stakeholders, including healthcare providers, payers, and software vendors.

As the medical community prepares to release ICD 11, healthcare providers need to ensure their billing and coding processes are up-to-date. Precision Hub offers a comprehensive medical billing and coding service to help you navigate the transition to ICD 11. Our team of professionals is trained in the latest coding guidelines and can provide accurate and efficient coding services. With our service, you can rest assured that your billing and coding processes are in accordance with the latest standards and will help you avoid any potential reimbursement delays or denials. Contact us today to learn how we can ensure your practice’s financial success.

How to Optimize the Denial Management Process?

denial management process

When effectively managing healthcare claims, one of the most important things to do is to establish a system that efficiently handles rejected claims. The majority of medical practice administrators are concerned about work allegations, particularly when they are denied. It is necessary to establish an efficient method for handling medical claims to resolve these claims. Even minor adjustments can significantly impact the amount of cash your practice’s revenue cycle generates.

Denied claims can be avoided by creating an effective denial management process that contributes to the bottom line. Your practice needs sound analytics, embracive technology, workflow automation, education, services, and professional support to achieve an efficient process.

Continue reading this post to learn more about the denial management process. The article presents some effective tips for denial management in medical billing.

So, let’s explore how to improve denial management in healthcare.

Denial Management Process

The denial management process is a closed-loop business procedure that entails investigating each denial and conducting root cause analysis to determine why each claim was denied. It involves analyzing denial trends to determine how payers behave, working with insurance companies and payers to overturn denials, and implementing procedures to prevent future denials. Denial management impacts the entire revenue cycle, from the front end (denial prevention) to the back end. How denied claims are processed impacts cash flow, reimbursement, and collection costs, as well as the teams responsible for patient access, clinical care, and health information management.

 Denial Management in Medical Billing

Denial Management in Medical Billing

Having an efficient denial management process is crucial for your practice’s success. Here are some tips on increasing the effectiveness of bringing in money and handling denied claims correctly.

Maintain a Streamlined Procedure

It is essential to maintain a streamlined process to keep track of denied claims in real-time. It helps monitor the status of claims throughout the entire procedure. You can quickly rectify the issue and resubmit your claim if it is denied. Denied claims that take a long time to resolve will significantly delay your practice’s cash flow. You can even avoid being required to resubmit within the specified time frame.

Identify Weak Areas

Utilizing denial management software can be extremely beneficial because it relieves your employees of the responsibility of reviewing claims and allows you to identify areas where necessary changes are required. You may also need to correct the coding errors or keep better track of patients and treatments to ensure that each plan covers them. Taking measures to address these concerns will increase the number of cleaner claims.

Employ Claim Scrubbing

Claim scrubbing examines billing codes for errors before sending them to insurers for payment. As a result, significantly fewer claims are denied or rejected, facilitating on-time payments. Incorrect codes cause most denials; fixing them can save time, money, and other resources.

Implement Automated Verification

One of the most common reasons for denied claims is that the patient’s insurance did not cover the service. It can occur for various reasons, including when the patient changes insurance plans without notifying the clinic or when the patient’s coverage expires. In any case, this error could result in significant financial loss. In healthcare, optimizing service time and making a profit is only possible by verifying coverage. Automation is a crucial step toward an efficient denial management process.

Outsource Denial Management

Given the importance of denial management to a business, it is best to outsource it to a company like Precision Hub, which specializes in Revenue Cycle Management systems. When outsourcing medical billing, you entrust the revenue cycle to individuals with extensive training and education. Medical billing should be outsourced if you are experiencing problems with your revenue cycle.

Apply Technological Advancements

Technology is necessary for proactively managing and preventing denials. Errors can be avoided, processes can be streamlined, and efforts to prevent and manage denials can be concentrated in the right areas if there is a seamless flow of information between departments. Real-time analytics with data-driven insights and robust reporting with root cause analysis further aid in optimizing the denial management process. Automation or other technological applications contribute significantly to managing front-end denials, thus ensuring a proactive denial management process.

To remain competitive in today’s advanced healthcare system and eventually reduce the likelihood of denials, you must act and implement the abovementioned strategies.

Denial Management in Healthcare

As the healthcare industry transitions toward value-based care, denials management will be useful for determining and tracking all the costs associated with value-based contracts. It is because denial management is based on the payment decisions made by insurance companies. When all aspects of patient care are considered, the financial success of many practices will depend on how well they handle denials, which distinguishes between losing and winning a contract.

Leaders in healthcare finance should continue to invest in denials management and emphasize its significance to the overall financial strategy. A successful program will generate an immediate return on investment (ROI) and position the healthcare organization to profit from long-term payment trends. By utilizing denial management systems, it is possible to compensate for losses since it is easier to check claims for errors and collect data before submission.

See Also: Denial Management Services for Emergency Medicine Physicians


Establishing an effective healthcare denial management system is the most important thing to increase profits. There are numerous reasons why the healthcare management system rejects increasing claims. Your claim may be denied if there are billing or coding errors. Practices must resubmit their claims to receive the payments. The most effective way for a practice to improve its bottom line is to optimize its denial management process and submit more accurate claims. Poor management of the claim processing can negatively impact the revenue cycle.

Precision Hub has a team of skilled medical billers and coders ready to assist you in maintaining a smooth revenue cycle. Our mission is to assist physicians in streamlining their medical billing to be paid more quickly and easily. Claim denials occur for numerous reasons, resulting in financial losses for healthcare professionals. Schedule a demo now to learn more about how we handle denied claims.

You can contact us and see how we can assist you in optimizing your denial management process. 

Why You Should Conduct Medical Billing Audit?

medical billing audit

A medical billing audit is a systematic process that employs in-depth inquiry and assessment to identify issues in the clinical documentation of provided services. Medical audits bring these issues to light. If these issues are resolved, accounts receivable will decrease, and revenue cycle management will be more successful.

A medical billing audit permits medical facilities to examine their billing procedures, the significance of their codes, and how they submit claims. The audit ensures that their system is functioning properly and helps them determine if they need to upgrade for improved performance. In addition, audits of medical bills reveal errors that, while not a problem, could become one in the near or distant future.

Let’s discuss why your practice should do medical billing audits.

Medical Billing Audit

A medical billing audit is a planned evaluation of the efficacy and dependability of clinical documentation and the complete medical billing procedure. The approach entails a comprehensive assessment of the practice’s health records and the medical billing data submitted to payers. It ensures the practice is aware of, tracks, and corrects any incorrect billing practices.

During a billing audit, the practice may be required to provide the following:

  • Clinical records (medical records, x-rays, lab reports)
  • Financial records (EOBs, accounts receivable ledger, and entered charges)
  • Policy-related documents (if requested by providers or the government)

The electronic health record (EHR) allows you to view these records.

Audits are conducted either before or after claims are submitted to payers. These sorts of audits are known, respectively, as prospective audits and retrospective audits. Some practices prefer prospective audits for new providers while retrospective audits for the existing ones.

Medical Billing Audits Approach

Medical Billing Audits Approach

Medical billing audits examine all aspects of the billing procedure, beginning with insurance verification and proceeding through ICD and CPT coding, claim filing, payment posting, follow-up, and denial management systems, and concluding with follow-up procedures. Audits of medical bills examine the billing and coding solely. They do not consider the type or quantity of care, whether it was necessary, how much it cost, or what the provider provided.

Benefits of Medical Claim Auditing

Some of the important benefits of medical billing audit are listed below:

1. Improved Coding Compliance

Medical billing audits can assist in identifying errors, obtaining guidance on fixing problems, building trust among the coding team, and ensuring that the most recent procedure codes are utilized. Audits are required to simplify and standardize the medical billing process. Procedures for medical billing must comply with HIPAA. If they are not, a medical facility and its billing partner could be subject to severe issues, such as legal penalties that would harm their reputation and cost them money. So, to avoid losses due to noncompliance, audits are crucial.

2. Strengthened Denial Management

Audits can improve claim performance by lowering the number of denied claims. Claim denials have a substantial influence on the amount of cash that is available to a healthcare provider. The most common denials reasons include the following:

  • Not being able to provide required pre-authorization
  • Not having enough paperwork
  • Errors in patient data or procedure codes
  • Submitting a duplicate claim
  • Submitting a claim after the payer’s deadline
  • A medical procedure not being deemed necessary
  • Not being eligible because the payer doesn’t cover it
  • Using an out-of-network provider

A timely medical claim auditing can prevent the majority of problems that lead to denials by identifying and correcting possible concerns and preventing further ones from occurring. It helps the practice’s financial resources and earnings develop over time, which benefits it.

3. Better Staff Understanding

Audits help administrative employees understand their responsibilities and prevent them from becoming overly frustrated. A culture of compliance and a stable work environment are beneficial outcomes of audits that save the administrative staff from frustration. Audits set the norm for employees by instituting policies and processes that foster a compliant, stable, and enjoyable work environment.

Streamlining a medical practice’s workflow due to a successful audit has numerous benefits, including increased productivity, improved communication, and more efficient time management. Audits assist administrative personnel in ensuring that claims are accurate and presented properly. It ensures the prevention of billing and coding errors.

4. Boosted Practice Revenue

Medical claim auditing guards against billing and claims fraud. When practices have an internal system of checks and balances, it is simple to determine if they are prepared for ICD-10-CM compliance and use electronic health data effectively. As a result, there are lesser chances of denials that turn profits the practice.

5. Payer-Provider Relationship

The relationship between a payer and a provider is crucial, similar to that between a patient and a physician. A medical claims audit is also advantageous since it improves relationships with payers. Payers appreciate it when claims are properly filled out and submitted. An audit will reveal any outliers, allowing the practice to determine what is wrong before a large payer discovers an issue and requests an external audit. Payers appreciate fewer disagreements, strengthening the business relationship between the medical provider or billing agency and the payers or insurance companies.

6. Enhanced Patient Care

Audits of medical claims contribute significantly to the enhancement of patient care. The entire practice switches its focus to the quality of care it provides. As a result of an audit, the practice tracks and monitors the services and treatments it provides and trains its doctors to provide the best care possible to its patients. When patients have a better experience, the revenue cycle and outcomes improve.

See Also: Why Outsource your Medical Billing Services?


A practice should conduct frequent audits of its medical billing to determine how effectively and efficiently it processes claims. A medical billing audit is essential for your healthcare organization since it will reveal areas where you may improve as a provider. It enhances the precision and speed of writing medical records. Auditing medical practices frequently are advantageous for healthcare organizations in numerous ways. You must employ an expert auditor to avoid difficulties and optimize your revenue cycle management.

Join us, and we will ensure that the billing and coding procedure is filled with happiness. Our medical billing specialists at Precision Hub will expedite the entire billing procedure for you. We will optimize your charges, submit your claims, ensure that you are paid on time, lower your accounts receivable, identify underpayments, and boost your practice’s net collections, resulting in improved clinical outcomes and service expansion.

You will also be assisted by a client manager solely responsible for your account. Additionally, the staff will be available 24/7 to answer your inquiries. So, please don’t wait and schedule a meeting with us to learn about our expert services.