Month: November 2011
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Dermatologists’ Shortage in the US – a Medical Billing Perspective
Contrary to mounting demand, US healthcare industry continues to be plagued by shortage of dermatologists – the physician-patient ratio has grown to be so unhealthy that patients have to wait as long as 38 days just to have an appointment with their physicians; there have even been extreme cases of…
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Standards of Ethical Medical Coding: Part 3
Healthcare Insurance industry requires stringent guidelines and ethical practices for the protection of patient information. The field of medical coding and billing falls under the same ethical guidelines as any other part of the medical industry. Coding is one of the core functions, and due to the complex regulatory requirements…
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Mastering the Reimbursement Battle Against Payers
Physicians are likely to face another cut in Medicare reimbursements of 27% in 2012, in a scenario where doctors state that insurers regularly underpay or flat out deny, as a matter of course, legitimate health insurance claims worth billions of dollars each year. According to American Association for Justice (AAJ)…
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CMS to Delay Enforcing 5010 Compliance
Center of Medicare and Medicaid announced that it will delay enforcing HIPAA 5010 transaction sets requiring hospitals, physician practices, health plans and claims clearinghouses to switch to using the ASC X12 Version 5010 standards for the electronic transmission of healthcare claims and other administrative communications until March 31, 2012 instead…
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Evaluating the Procedural Constituents of Medical Claim Management Cycle
Given the alarming statistics about medical billing industry average – 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed or written off by providers, 50% of denied claims are never re-filed, and 50-70% of denied claims have higher chance of being recovered –…
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Strategic Management of Physicians’ Day-to-Day Operational Issues
Unlike physician practices of yesteryear’s, physician practices today have found themselves surrounded by a larger pool of stakeholders: patients, government, and insurance carriers. While physicians commitment to quality medical services continues to be unquestionable, their ability to comply with escalating government’s healthcare norms, and insurance providers’ stringent reimbursement policy has…
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New Analytics Model for Future Fraud and Abuse System
The Center for Medicare and Medicaid services is poised to take bigger steps in preventing fraud and abuse by increasing its monitoring and analytics capabilities. CMS will conduct enrollment and medical claims analytics to keep frauds out of Medicare, for this some necessary technology is already deployed, while the other…
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