Challenges in Securing Reimbursements For any practice owner, submitting error-free claims and securing accurate insurance reimbursements is the most important and at the same time most challenging task. Things even get worse due to sloppy billing and coding mistakes practices. As per CMS (Centers for Medicare & Medicaid Services), Medicare, claims worth $6.25 billion in […]
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 Fund Transfer) and ERA (Electronic […]
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 essential questions regarding provider preferences […]
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 below-mentioned telecommunication billing updates for […]
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 facility-based providers, including anesthesiologists, are […]
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) adopted certain electronic standards for […]
Recently Healthcare Financial Management Association (HFMA) conducted a survey on day-to-day challenges faced by small practice owners. This survey revealed that frontline healthcare workers are not the only ones facing staffing shortages. Registrars, billing specialists, and patient follow-up staff were the most in-demand revenue cycle management positions. The survey gathered responses from more than 400 […]
Unique Medical Billing Operations in the Year 2022 With a considerable number of claims being denied, most medical practices have struggled during the COVID-19 pandemic. Recently, Apollo Healthcare has published its finding on how physicians are coping with the unique challenges of the COVID-19 pandemic. According to the ‘2022 Apollo Healthcare Predictions Report’, US doctors […]
Medicare, Medicaid, and private payers had relaxed their billing guidelines and revised reimbursement policies so that physicians can provide better care during the COVID-19 pandemic. A Public Health Emergency (PHE) was declared for the same by the federal government. In March 2020, a public health emergency (PHE) declaration was issued under Section 201 of the […]
Most practices are struggling to stay afloat due to shrinking reimbursements and the recent impact of the COVID-19 pandemic. The days of submitting an insurance claim and getting paid within 30 days are long gone. Various payer billing guidelines and reimbursement policies after the end of the Public Health Emergency (PHE) make it really difficult […]
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