In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Chronic Care Management (CCM) and Principal Care Management (PCM) and increased reimbursement for already existing codes in the same categories. These codes are […]
Understanding False Claims Act As a healthcare practice, you can typically submit claims to Medicare or Medicaid. Your claims are bills for goods you provide and services you conduct for patients. These federal health insurance programs cover the costs associated with your services. The False Claim Act is a federal law that makes it a […]
As a healthcare provider, during your residency, you probably are not focused on who pays for your patients’ care. Once you start practicing, it is important to understand who the payers are. The U.S. healthcare system relies heavily on third-party payers, and, therefore, your patients often are not the ones who pay most of their […]
On 19th May 2022, the American Medical Association (AMA) announced an update to Current Procedural Terminology (CPT®) including new product and administration codes assigned to the Moderna COVID-19 vaccine for children 6 months through 5 years old. While the Moderna COVID-19 vaccine for young children has yet to receive FDA authorization, AMA has created a […]
Throughout the COVID-19 pandemic, CMS and government agencies provided flexibilities to healthcare companies to use popular technology and applications to better engage with their patients. One example is the Department of Health and Human Services’ Office of Civil Rights (OCR), which issued a notice that it will allow healthcare providers to use widely available communications […]
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 […]
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