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Revenue Cycle Management (RCM)
Top 5 Challenges with Healthcare Revenue Cycle Management
If you have ever come across or worked in a healthcare organization, you must be aware of the importance of medical claims and how it can put financial constraints in your revenue cycle when rejected. The administrative work of a healthcare facility is different from other industries as a clinical…
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Medical Billing Services
Understanding Medicare’s Outpatient Mental Health Treatment Limitation
By law, Medicare payment for outpatient mental health services is limited to 62.5 percent of covered expenses incurred in any calendar year in connection with the treatment of a mental, psychoneurotic or personality disorder for an individual who is not an inpatient of a hospital at the time the expenses…
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Medical Billing Services
How to Fill SNFABN (Skilled Nursing Facility Advanced Beneficiary Notice of Non-coverage)
The SNFABN provides information to the beneficiary so that he can decide whether or not to get the care that may not be paid for by Medicare and assume financial responsibility. SNFs must use the SNFABN when applicable for SNF Prospective Payment System services (Medicare Part A). SNFs will continue…
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Medical Billing Services
Ostomy Documentation Tips
For the 2018 reporting period, insufficient documentation accounted for 81.6 percent of improper payments for ostomy supplies. Additional types of errors for ostomy supply claims in the 2018 reporting period were no documentation (2.3 percent) and medical necessity (1.9 percent). Medical records must contain adequate, clear documentation that supports the…
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Medical Billing Services
Critical Care Services and Medical Necessity
Critical care services must be medically necessary and reasonable. Services provided that do not meet critical care services or services provided for a patient who is not critically ill or injured in accordance with the above definitions and criteria but who happens to be in a critical care, intensive care,…
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Primary Health Care
Primary Care First (PCF) and Alternative Payment Models
Primary Care First Model Options is a set of voluntary five-year payment options that reward value and quality by offering an innovative payment structure to support the delivery of advanced primary care. It will help in prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high…
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Practice Management
POP for Simplifying Documentation Requirements
Patient over Paperwork (PoP) Initiative Through ‘Patients over Paperwork,’ CMS established an internal process to evaluate and streamline regulations with a goal to reduce unnecessary burden, to increase efficiencies, and to improve the beneficiary experience. As part of Patients over Paperwork Initiative, Medicare is simplifying documentation requirements so that providers…
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