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(3) CPT/HCPCS codes are separated into the following 23 CPT/HCPCS code groups: Allergy immunotherapy, allergy testing, cardiovascular, chiropractor, consults, emergency room visits and observation care, hearing/speech exams, immunizations, inpatient visits, maternity/cesarean deliveries, maternity/non-deliveries, maternity/normal deliveries, miscellaneous medical, office/home/urgent care visits, outpatient psychiatry/alcohol and drug abuse, pathology, physical exams, physical medicine, radiology, surgery, therapeutic injections,
Billing
Crafting a Comprehensive Approach to Billing Compliance:The convergence of internal and external market dynamics presents a golden opportunity for healthcare finance leaders to reassess their billing and compliance procedures. Externally, both federal and commercial payors are intensifying audits and scrutinizing pre-payment claims, delaying cash flow, increasing the risk of penalties and clawbacks, and jeopardizing the financial bottom line of healthcare organizations nationwide.?
Billing
Health Insurers Are Ignoring Price Transparency Rules at the Expense of Private Practice:Since January 1, 2023, the Transparency in Coverage Rule required health insurance providers and health insurers to provide price information to participants in a publicly accessible place. This means consumers should, in theory, be able to go to any payor’s website and see what different doctors, hospitals, and health systems are charging for the same services. The law was meant to allow consumers the ability to shop for healthcare services based on cost and, thus, hopefully lower their healthcare expenditures.
Billing
Understanding Basics of Behavioral Health EOB:Understanding how insurance companies work can be a challenging task for behavioral health providers. Navigating Explanation of Benefits (EOBs) is crucial for ensuring proper reimbursement and a smooth claims process. This guide will equip you with the knowledge to decipher these often-confusing documents.
Billing
Basics of Billing for New Patient Visits in 2024:New patient visits can be bustling hubs of activity, but ensuring flawless billing for new patient visits shouldn't add to the chaos. This article equips primary care providers with the latest knowledge and technical expertise to navigate the process seamlessly, maximizing new patient visit billing accuracy and minimizing compliance risks.
Billing
The Hidden Costs of Using an Ineffective Payment Processing System:At any given time, over a billion payments are being processed online, and this includes healthcare services. That's because patients today want the ease and speed of transactions that traditional methods simply don't offer. Plus, healthcare practices have extra peace of mind knowing that modern technology gives them security protections to keep their patients' data safe. This is where a payment processing system comes in.
Billing
Medicare Proposed Rule for 2024 Will Not Improve Radiology Reimbursement :The Centers for Medicare and Medicaid Services (CMS) announced its proposed Medicare Physician Fee Schedule (MPFS) rules for 2024, including provisions for the Quality Payment Program (QPP). While not a done deal until the final rule is issued toward the end of the year, the Proposed Rule gives an indication of where CMS is headed with regard to payment policy. In recent history, even the Final Rule isn’t final because Congress has had to intervene to stave off significant reimbursement reductions. Here are the highlights of the 2024 Proposed Rule.
Billing
Medical Billing Values:Medical billing is not always an easy profession. Medical billers must interact with the medical care triad: the provider, the patient, and the insurance company. Medical billers face audits, upset patients, disreputable insurance companies, and fellow medical billers.
Billing
Comparative Billing Reports (CBRs): What Are They, and What Do We Do With Them?:CMS (Centers for Medicare and Medicaid) is always implementing various programs and initiatives aimed at reducing fraud, waste, and abuse. One such initiative is Comparative Billing Reports (CBRs). In this article, an overview of CBRs, their purpose, and how they can benefit coding professionals, auditors, and practice managers will be discussed.
Billing
Medical Necessary Denials:In 1988, Samuel and Winona decided to have a baby. Samuel, worked at a small sneaker factory outside of Boston where they treated their employees well by providing health insurance as part of their employment. The factory was not a government employer, or a church which meant that the health insurance was protected by the Federal law and Federal Regulation known as the Employee Retirement Income Security Act (ERISA).
Billing
Investigation of Hospitals Hiding Prices from Patients:The Federal Hospital Price Transparency Rule helps Americans know the cost of a hospital item or service before receiving it. Compliance is mandatory. The regulation aims to improve the affordability of hospital care by promoting price competition. However, a low compliance level among hospitals would compromise the operational effectiveness of this regulation. Understanding hospitals' compliance status to the regulation has important implications for its enforcement effort and effectiveness assessment.
Billing
Verno's Voice: Debt Collection:I was born into debt collection. In 1953, both my parents quit high school in their final year. In 1953, if you quit school, you were a social pariah; no one would hire you, because it was deemed that if you quit school, you would also quit your job. My parents did find work at a small mom and pop diner, but it barely paid the rent, so we moved to a run-down apartment next to the railroad tracks. The medical bills for my birth were overdue, and the debt collectors came to our apartment. In the 1950s, there were no debt collection laws, so debt collectors did everything possible to collect what was owed.
Billing
Biden National Cyber Strategy Poses Challenges to Healthcare:The Biden administration's newly released national cybersecurity strategy aims to bolster protections across all critical infrastructure sectors, including setting minimum security requirements, enhancing collaboration, and making other important moves.
Billing
Get Reimbursed With Billing Guidelines for Audiology Services:When billing for audiology services, you need to be careful how you are billing for professional skills and technical skills. Technical component is taken care of by an experienced technician using a specific protocol under the direction of a supervising physician.
Billing
How to Outsource Medical Billing for Oncology Practices:There are certain billing aspects that oncology practices ought to know before hiring third-party billing companies. Oncology medical billing is complex, and medical practices need experts who can handle the revenue cycle management process.
Billing
January is Thyroid Awareness Month: Understand the Symptoms and Risk Factors of Thyroid Disorders:January is Thyroid Awareness Month. The main goal of this annual campaign is to encourage people to learn how to recognize symptoms and risk factors of thyroid disease and the need to seek treatment. According to the American Thyroid Association (ATA), an estimated 20 million Americans have some form of thyroid disease, and up to 60 percent of those with thyroid disease are unaware of their condition.
Billing
Regulatory Update: Radiology Faces Revenue Cuts in 2023:Once again this year, physicians are uncertain about the amount of reimbursement reduction they will suffer from Medicare cuts. If things are left unchanged, Medicare providers will face a reduction of approximately 8.5% across the board, without considering adjustments made to specific procedure codes.
Billing
Payers Wrongly Cutting Payments to Physicians for E/M Services:Payers have been wrongly cutting payments to physicians for evaluation and management (E/M) services - often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding.
Billing
A Case Study on Radiology Billing:Billing for radiology correctly requires more than just keeping track of money. It is a multi-phase process that necessitates persistently calculating money on each step. Throughout the expanding process, one needs to be tenacious and proactive to ensure collection of every cent which is due.
Billing
How MBC Can Help in Reducing Your Gastroenterology Billing Errors:Gastroenterology billing and coding is complex and challenging as gastroenterologists provide both medical and surgical services. Accurate, efficient billing and coding for gastroenterology services ensure the survival of the practice amidst various challenges like the COVID-19 pandemic.
Billing
What You Need to Know About Physical Therapy Billing:Physical therapists, like any healthcare provider, generally don't get into the profession because they like working with numbers. But no practice is going to succeed without a good understanding of the complex medical billing system.
Billing
Billing and Coding: Bone Mass Measurement:The following is guidance for billing, coding, and other guidelines in relation to local coverage policy L36460-Bone Mass Measurement. This is an excerpt from the article written by Centers for Medicare & Medicaid Services.
Billing
Declaration of Blanket Waivers for SNFs:In a recent change to the way skilled nursing facilities (SNFs) are regulated, the Centers for Medicare and Medicaid Services (CMS) has issued a declaration of blanket waivers for SNFs.
Billing
Five Facts about Split Visits:Got five minutes? You can learn five things about the crazy 2022 rules for Split Visits. Hopefully, this will end a lot of the confusion around these relatively new rules.
Billing
Why Health Insurance Companies Hate Price Transparency:More than a year ago, the federal government passed the Healthcare Price Transparency Act, which was primarily directed toward hospitals. Under the rule, hospitals are required to display their prices and allowed amounts in a machine-readable and consumer-friendly format.
Billing
Part 1: Managing Denials Is Important to Good A/R Hygiene:Revenue cycle management includes tracking claims, making sure payment is received, and following up on denied claims to maximize revenue generation. Several metrics can help you determine whether your revenue management cycle processes are efficient and effective.
Billing
No Surprise Billing Act: What You Need To Know:The No Surprise Billing Act may be the most poorly written, difficult to understand set of regulations I have encountered in my legal career. Stark is much, much easier to understand. Much of the guidance out there is misleading, if not entirely wrong. Here is a short explanation of what you need to know.
Billing
Pathology Billing Services: All You Want to Know:Pathology, being the medical science dealing with the cause-and-effect theory of diseases, is an important sector. Similarly, the medical billing and coding process is an important part of all medical practices, including pathology.
Billing
Billing Dental Implants Under Medical Coverage:Implants can be costly to the patient and the provider, and it is crucial to understand how to bill a patient's medical insurance to ensure there is adequate coverage for the best treatment. Implants are commonly billed in a dental office under a patient’s medical benefits.
Billing
Sending Surprise Medical Bills to Patients? Think Again:"Requirements Related to Surprise Billing; Part I" is an interim final rule related to Title I (the No Surprises Act) targeting health care providers with the purpose of restricting excessive out of pocket costs to consumers from surprise billing and balance billing. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans.
Billing
Case Study: Managing Patients, Payments, and a Pandemic:The COVID-19 pandemic has accelerated demand for contactless experiences that are both digital and convenient across the entire range of patient interactions. However, one of the strongest preferences expressed by healthcare consumers-for online systems to receive and pay bills-has been largely unmet because of legacy mechanisms that require patients to interact with staff and decipher often-confusing paper statements.
Billing
Avoid These Top 5 Medical Billing Mistakes:Even the most organized healthcare organizations can still fall victim to the most common medical billing mistakes in the industry. Providers who have in-house billing services know the administrative burden that comes with it.
Billing
Avoid These Top 5 Medical Billing Mistakes:Even the most organized healthcare organizations can still fall victim to the most common medical billing mistakes in the industry. Providers who have in-house billing services know the administrative burden that comes with it.
Billing
Medical Billing Companies: We Are Not a Commodity:Have you ever wondered why sometimes it seems that the relationship between medical practices and their billing companies on not on a level playing field? I have and it leaves me confused as to why relationships deteriorate even when the billing company is producing excellent results.
Billing
The Pain of an Unfaithful Billing Partner:In the vast majority of business and industry, the entity itself takes full responsibility for invoicing (billing) its customers or clients. Hospital-based physician practices are uniquely different.
Billing
Coronavirus Vaccine Update - Billing Codes:The American Medical Association approved two coronavirus vaccine CPT Codes, 91300 and 91301. Two codes are being used to better track, report, and analyze data for the planning and allocation of vaccines for coronavirus.
Billing
Surprise Billing:Today I'm writing about a man, a man named Steve. Steve is married, has health insurance, and works for a local movie theater.
Billing
CMS Develops Additional Code for Coronavirus Lab Tests:Today, the Centers for Medicare AND Medicaid Services (CMS) took additional actions to ensure America's patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).
Billing
CDI Integrity:There recently has been much discussion on the merits of changing the name of the CDI profession
Billing
Rhizotomy Procedures :The CPT coding choices for a rhizotomy procedure reflect the methods chosen to destroy the nerve
Billing
The New Medicare Cards:In an effort to help protect beneficiaries from fraudulent use of their social security numbers
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