Keeping Your Practice Profitable During Pandemic

Maximizing profitability and practice collections is the main objective for successful medical practices. In a time of this pandemic, however, practice profitability became even more critical. Your practice’s profitability depends on a variety of factors that aren’t always under your control, particularly during times of crisis. But rather than looking at this pandemic situation as […]

Reducing Medical Billing Staff Burnout

According to MGMA’s (Medical Group Management Association) report, amongst the COVID-19 pandemic, burnout among medical billing staff becomes an overwhelming problem. MGMA reported a combined 30% turnover rate specifically among front office and operational staff, the highest of any other healthcare career category. Continuously changing payer policies and reimbursement guidelines put additional pressure on medical […]

Proposed Changes to Shared Visit Billing

Basics of Shared Visit Nurse practitioners (NPs) or physician assistants/physician associates (PAs) and physicians sometimes ‘share; patient visits. A shared visit which is also called a split visit is one where both types of clinicians participate in evaluating and managing a patient on a given day. The Centers for Medicare & Medicaid Services (CMS) defined […]

Basics of Value-Based Contract (VBC)

Defining Value-Based Contract (VBC) A value-based contract (VBC) is a written contractual arrangement between parties in which the payment for health care goods and services is tied to predetermined, mutually agreed upon terms that are based on clinical circumstances, patient outcomes, and other specified measures of the appropriateness and effectiveness of the services rendered. In […]

Avoiding Healthcare Fraud and Abuse

Providers face multiple healthcare fraud and abuse laws at the local, state, and federal levels. Fraud and abuse cases in the healthcare industry cost billions of dollars a year. Healthcare fraud and abuse situations include submitting false claims; billing for medically unnecessary services; billing and coding errors; billing for services that were provided by unlicensed […]

7 Tips to Improve Patient Registration Process

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 […]

Can Providers Waive Copays and Deductibles?

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 […]

Understanding Anti-Markup Rule for Diagnostic Tests

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 […]

Surprise Billing: What Providers Must Know

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 […]

Busting Common Medical Billing Myths

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 […]

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