What is Medical Auditing? How it can be Performed?

Medical auditing entails conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are running an efficient and hopefully liability-free operation. Quality health care is based on accurate and complete clinical documentation in the medical record. The best way to improve your clinical documentation and the livelihood of your healthcare organization […]

Why Medicare Isn’t Paying You?

There are two main categories of services for which a physician may not be paid by Medicare: Services not deemed medically reasonable and necessary Non-covered services In some instances, Medicare rules allow a physician to bill the patient for services in these categories. Understanding these rules and how to use them in your practice increases […]

Received Payer Request for Medical Records? Keep Calm and Take These Steps

If a letter were to arrive at your organization in an innocuous-appearing envelope, you may be afraid to open it. It’s unsettling for a payer to request medical records for claims that have already been paid. It is becoming more and more common for providers to receive what appear to be innocuous medical records requests […]

What is MIPS and How it Affects My Practice?

What is MIPS? On November 1, 2018, CMS released revisions to payment policies under the Medicare Part B physician fee schedule for the Quality Payment Program (QPP) for the calendar year 2019. In accordance with one of the most bipartisan and significant legislative changes to Medicare in a generation, the Medicare Access and CHIP Reauthorization […]

Easy Tips for Quick, Accurate and Simplifying the Provider Credentialing Process

Medical Credentialing is a process whereby insurance networks check to make sure that the provider meets the standards set out by the insurance company. In this process, they review a range of documents including medical licenses, malpractice insurance, schooling information, and background checks. Credentialing is performed on an individual state-to-state basis. Whether you are adding […]

Time-Based Billing for CPT Evaluation and Management

Within the guidelines of the CPT code book, CPT has stated; “When counseling and/or coordination of care dominates (more than 50%) the physician/patient and/or family encounter (face-to-face time in the office or other outpatient setting or floor/unit time in the hospital or nursing facility), then time may be considered the key or controlling factor to […]

How to Deal with Patient Responsibility?

As patient responsibility balances climb, practice owners are seeking effective methods of collecting outstanding patient balances and ways to collect more payment at the time of service. Estimating patient responsibility prior to claims adjudication is a tricky business. However, practices can absolutely figure out a payment estimation plan that suits their needs and support the […]

What is the Insurance Credentialing Process?

Credentialing is a process that the insurance companies use to verify your education, training, and professional experience and to ensure that you meet their internal requirements for serving as an in-network provider on their panel. The goal of the insurance credentialing process is to become in-network and prevent your patients from having claims go towards […]

CAQH and Insurance Credentialing

What is CAQH? Council for Affordable Quality Healthcare, Inc. (initialized as CAQH) is a non-profit organization incorporated in California as a mutual benefit corporation. It is essentially an online portal that stores provider information in a secure, collaboration database. This secured information is granted to health insurance companies during the credentialing process to make acquiring […]

How to use Modifier 25 Accurately for Medicare

Modifier 25 is used when a minor procedure (one with a 0- or 10-day global period) and a significant and separately identifiable evaluation and management (E/M) service are performed during the same session or day. Modifier 25 (significant, separately identifiable evaluation and management [E/M] service by the same physician on the same day of the […]

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