Medical Billing

After Medicare and Medicaid, the patient is payer number three for most healthcare providers! This means your healthcare business must evolve to ensure revenue stability while maintaining operational expenses. Rather than hiring additional staff to tackle mounting self-pay accounts, or worse, writing off collectible balances that that are charged off to bad debt, use these…

The majority of insurance carriers are mandated to deny or pay a claim within 30 days of receiving it. As a practice, you know you need to receive payment from the carrier (and the patient, for that matter) as quickly as possible. You also know this doesn’t always happen. Why? A Proactive Approach A few…

In April of 2018 and continuing for one year, the Centers for Medicare & Medicaid Services (CMS) will launch new Medicare cards. Called Medicare Beneficiary Identifiers (MBIs), these new numbers will replace the current health insurance claim numbers (HICN) that are social security numbers. The idea is to help prevent Medicare fraud and help beneficiaries…

Also known as form CMS-R-131, applying the ABN when needed might be among the most misunderstood areas for Medicare providers. The purpose of the ABN is: If Medicare does not cover a service or treatment you have provided a patient, you can collect from the patient only if you have communicated the cost, that the…

The Centers for Medicare & Medicaid Services (CMS) decided to reimburse providers as a monthly fee for remote patient monitoring (RPM) billed under CPT code 99091. The services are defined as “collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician…

Continuous changes in health insurance reimbursement guidelines result in an often complex medical billing scenario. This is unlikely to change. Evaluate your intake to charge to claim submission workflow and follow the basic best practices to target preventable denials and maximize reimbursement on the first pass. With insurance company requirements, provider input and government regulations…

The flexibility offered during the transition to ICD-10 coding disappeared as of October 1, 2016. Now, all providers need to precisely reflect clinical documentation per the coding guidelines and assign codes to the highest degree of coding specificity. A lack of documentation supporting the code can lead to the dreaded claim denials. The Cancer of…