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REVENUE CYCLE MANAGEMENT

No Surprises Act (NSA), Federal IDR and how it works?

No Surprises Act (NSA), Federal IDR, and how does it work?

The 2020 No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, which took effect on January 1, 2022. For emergency patients visiting a hospital or freestanding...
The No Surprises Act and What It Means for Emergency Rooms

The No Surprises Act (NSA) and What It Means for Emergency Rooms

The 2020 No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, most of which took effect January 1, 2022. Below is a summary of the...
Ultrasound CPT Codes 2022

Ultrasound CPT Codes 2022

Diagnostic Ultrasound Procedures CPT Code range 76506- 76999. The Current Procedural Terminology (CPT) code range for Diagnostic Ultrasound Procedures 76506-76999 is a medical code set maintained by the American Medical Association. Ultrasound...
Understand and Recognize the Types of CPT Codes 2022

Understand and Recognize the Types of CPT Codes 2022

What are CPT Codes? Current Procedural Terminology, more commonly known as CPT codes, refers to a set of medical codes used by physicians/providers, non-physician practitioners, hospitals, outpatient facilities, and laboratories to describe...
CO 6 Denial: The procedure code is inconsistent with the patient's age

CO 6 Denial: The procedure code is inconsistent with the patient’s age

  CO 6 Denial Code: The procedure/revenue code is inconsistent with the patient's age When the claim says CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, it...
Denial Code CO 204 - Not Covered under the Patient's current benefits plan

Denial Code CO 204 – Not Covered under the Patient’s current benefits

  Denial Code CO 204 - Not Covered under the Patient's current benefits plan   With a valid Advance Beneficiary Notice (ABN): PR-204: This service, equipment and/or drug is not covered under the patient's...
Updated List of Freestanding Emergency Rooms in Texas

Updated List of Freestanding Emergency Rooms in Texas

  What is a Freestanding Emergency Room? A freestanding emergency department (FSED) is a licensed facility that is structurally separate and distinct from a hospital and provides emergency care. The Texas Freestanding Emergency Medical...
CO 119 - Benefit Maximum for this Time Period has been Reached

CO 119 & PR 119 – Benefit Maximum for this Time Period has been...

  (MEDICARE DOES NOT PAY FOR THIS MANY SERVICES OR SUPPLIES) CO -119 Benefit maximum for this time period or occurrence has been reached. Check Benefit Information through website/Calls If NO - Call the carrier...
Insurance denial CO 39: Authorization/Referral Problem

Insurance denial CO 39: Authorization/Referral Problem

  Insurance denial CO 39: Services denied at the time Prior authorization/pre-certification was requested Some carriers insist on obtaining prior authorization from them before the surgery.  This may be for certain specific procedures...
Denial Code CO 47: Diagnosis Missing or Invalid

Denial Code CO 47: Diagnosis Missing or Invalid

  Denial Code CO 47: Diagnosis Missing or Invalid   Insurances Company will be denying the claim with  CO 47 Denial Code: This (these) diagnosis (es) is (are) not covered, missing, or are invalid,...