The first element of the revenue cycle starts with patient registration. From the minute a new patient begins the registration process, it’s crucial that you are asking for and receiving correct information. If any information is omitted, given incorrectly, or entered incorrectly by the front desk then it will lead to incomplete and/or incorrect claim […]
Healthcare service providers sometimes waive patient financial responsibility i.e., Copays and Deductibles as an accommodation to the patient, professional courtesy, and employee benefits. However, waiving co-pays and deductibles may violate fraud and abuse laws and payer contracts. For a payer, waiving co-pays and deductibles creates two problems. First, payers require co-pays to discourage overutilization and […]
Anti-Markup Rule The Anti-Markup Rule prohibits a billing physician or other supplier from marking up either the Technical Component (TC) or Professional Component (PC) of a diagnostic test ordered by the billing physician or other supplier (or ordered by a party related to such physician or other suppliers through common ownership or control) unless the […]
Requirements Related to Surprise Billing Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued ‘Requirements Related to Surprise Billing; Part I, ‘an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise […]
Medical billing is the most important yet underestimated part of your healthcare organization’s revenue cycle. However, there are a few things that are commonly believed about them that just aren’t true! These myths range from considering medical billing as a data entry process to misconceptions about outsourcing. We wanted to clear up some of the […]
One of the biggest challenges for healthcare providers is boosting patient responsibility collection. Due to lower monthly premiums, more individuals are choosing plans with higher deductibles and more out-of-pocket expenses for services. This increase in patient portion for medical services is a major challenge for healthcare revenue cycle management. As more patients are opting for […]
When a healthcare provider wishes to appeal a denied Medicare claim (Fee-for-Service), Medicare offers five levels in the Part A and Part B appeals process. Five-level areas: First Level: MAC Redetermination, Level Two: Qualified Independent Contractor (QIC) Reconsideration, Level Three: Office of Medicare Hearings and Appeals (OMHA) Disposition, Level Four: Medicare Appeals Council (Council) Review, […]
Urgent care billing and coding is more challenging than other primary care medical billing and coding. Various payer reimbursement policies, frequent coding changes, and high deductible health plans increase difficulties for urgent care billing. According to the American Academy of Urgent Care Medicine, as many as 100 new urgent care clinics open every year but […]
Most practice owners are hesitant to outsource their medical billing and coding functions. Practice owners are familiar with basic medical billing and coding functions and try to do everything on their own. They will code themselves, use modifiers and will submit the claim, and will for insurance reimbursements. They will use online knowledge available for […]
When any patient comes to you for medical services, his primary concern is getting health needs addressed. The last thing he wants to deal with is navigating the complicated process of medical billing and dealing with his insurance provider. Any patient walking in wants the payment and claims process to be quick, easy, and seamless […]
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