Defining ‘New Patient’ According to the CPT definition, a new patient has not received professional services from the physician or another physician in the same specialty and group practice within the last three years. Accurate differentiation between new and established patients, alongside the correct usage of the New Patient CPT Code Range, is critical for […]
There are several reasons why healthcare providers are not hiring an in-house medical billing team. The reasons include high cost, limited expertise, high employee turnover, and compliance risk. Limitations of In-House Medical Billing Team There are several limitations of having an in-house medical billing team, including: Cost: Maintaining an in-house billing team can be expensive. […]
As anesthesia billing can be complex, it is important to avoid common pitfalls to ensure that claims are processed correctly and payment is received in a timely manner. Here are some tips to avoid common anesthesia billing pitfalls: Avoiding Common Anesthesia Billing Pitfalls: 1. Inaccurate Anesthesia Coding Some of the common anesthesia coding errors include […]
Significance of Insurance Claim Submission Running a successful healthcare practice is much more challenging than delivering high-quality patient care services. Whether you are running a solo practice, a laboratory, a hospital, or a dental clinic, there are several things you need to get right, including insurance billing. Receiving accurate insurance reimbursements is considered the backbone […]
False Claims Act in Healthcare The False Claims Act (FCA) in healthcare (also called the ‘Lincoln Law’), is a federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal government’s primary litigation tool in combating fraud against the government. The federal False Claims Act makes it illegal to: […]
CPT codes for Evaluation & Management (E&M) services are principally included in the CPT code range 99202-99499. The codes describe the site of service (e.g., office, hospital, home, nursing facility, emergency department, critical care), the type of service (e.g., new or initial encounter, follow-up or subsequent encounter), and various miscellaneous services (e.g., prolonged physician service, […]
Medical practices sometimes equate improper payments with medical billing fraud. Improper payments could be unintentional where your received payment even after not meeting program requirements. While medical billing frauds are intentional where practices might through up-coding and unbundling try to receive more insurance reimbursements than allowed. For differentiating between improper payments and medical billing fraud, let’s […]
Strengthening Affordable Care Act (ACA) Recently, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality healthcare options for millions of consumers. This proposed rule would increase […]
Significance of Patient Experience There is no question that patient experience is a huge factor when it comes to the success of your practice. In case of negative patient experience, their word-of-mouth can adversely impact future patients as well as their willingness to pay bills in a timely manner. The patient experience begins as soon […]
Basics of No Surprises Act The No Surprises Act went into effect on January 1, 2022. This Act is aimed at reducing ‘surprise bills’ to patients in the context of services provided at hospitals and ambulatory surgical centers and includes requirements for hospitals and ambulatory surgical centers, as well as physicians providing services at such […]
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