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DME Billing Services
Basics of Medicare Remittance Advice (RA)
The A/B Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) send to providers, physicians, and suppliers, as a companion to claim payments, a notice of payment, referred to as the Remittance Advice (RA). RAs explain the payment and any adjustment(s) made during claim adjudication.…
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Revenue Cycle Management (RCM)
Making a Stronger RCM Team in 2022
A recent survey of U.S. healthcare organizations highlighted declining reimbursements as a top industry challenge. The COVID-19 pandemic changed payer billing guidelines, and reimbursement policies made receiving accurate reimbursement tougher. Reimbursement complications often lead to documentation and coding inaccuracies leading to increased claim denials. The healthcare reimbursement process requires complicated…
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Medical Billing Services
Data Fields in Medicare EFT Enrollment
Electronic Funds Transfer (EFT) allows Medicare to transfer payments directly to the provider’s financial institution. The Medicare EFT Authorization Agreement (CMS-588) is required for: new provider enrollments; enrolled providers who are not already on EFT; and requesting a change to your existing EFT account information. Most providers find EFT (Electronic…
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Medical Billing Services
Accurately Submitting Medicare ERA Enrollment Form
Most providers face significant challenges when enrolling to receive ERAs (Electronic Remittance Advice) from any Medicare health plan. Some of the challenges include: a wide variety in data elements requested for enrollment; variety in the enrollment processes and approvals to receive the ERA; Absence of critical elements that would address…
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Medical Billing Services
Telecommunication Billing Updates for OTPs
As of January 1, 2020, CMS pays Opioid Treatment Programs (OTPs) through bundled payments for opioid use disorder (OUD) treatment services in an episode of care provided to people with Medicare Part B (Medical Insurance). As of January 1, 2021, Medicare Part B covers hospital outpatient OTP services. All the…
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Medical Billing Services
Surprise Medical Billing for Anesthesiologists
Basics of Surprise Medical Billing Out-of-network billing, or ‘surprise medical billing,’ occurs when a patient receives a bill for the difference between the out-of-network provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductibles. These bills can be unanticipated by patients, who often assume that…
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Medical Billing Services
Basics of EDI Enrollment with Medicare FFS
What is EDI Enrollment? For a provider is trying to enroll with Medicare FFS, they must first establish an Electronic Data Interchange (EDI) agreement with Medicare. EDI is the process of using nationally established standards to exchange electronic information between business entities. The Department of Health and Human Services (HHS)…
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