A modifier is a two-digit numeric or alphanumeric character reported with an HCPCS Modifier code, when appropriate. Modifiers are designed to give Medicare and commercial payers additional information needed to process a claim. This includes HCPCS Level I (Physicians’ Current Procedural Terminology [CPT®]) and HCPCS Level II codes. A modifier provides the means by which […]
There are several major issues facing compliance officers today, such as HIPAA, Stark Law, and Anti-kickback Statute issues, as well as many billing compliance issues. Billing issues continue to appear in federal government False Claims Act settlement agreements and government audit reports. Here, we’ll discuss incident-to and shared billing compliance pitfalls and focus on what […]
Prior authorization is a check run by some insurance companies or third-party payers before they will agree to cover certain prescribed medications or medical procedures. There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. A failed authorization […]
High-Deductible Health Plans (HDHP) have become increasingly popular since the Medicare Modernization Act of 2003 authorized portable, tax-advantaged health savings accounts (HSAs) designed to be coupled with these plans. Supports of HDHP advocate that, these plans as an effective mechanism for controlling health care costs by creating cost-conscious health care consumers who will look for […]
Medical Practice complains about the volume of incoming telephone calls and how much time their employees spend handling them. Why is your Medical Practice getting so many calls? It is the only way patients can make or change appointments. Patients call the office for refill authorization. Patients were distracted during their visits and are calling […]
As the present USA healthcare trends focusing more on Reimbursement Methods like value-based care, the fee-for-service is under intense scrutiny. Often labeled as an antiquated payment model, it promoted over-utilization by physicians and patients, while creating fragmentation among healthcare service providers. The Affordable Care Act of 2010, along with MACRA legislation in the year 2015, […]
HCC is also known as hierarchical condition category bank on ICD-10 coding. The coding is assigned to risk scores to patients. Each HCC is mapped to a precise ICD-10 code. Let MBC handle your HCC Coding so that you can focus on your core practice. In today’s hyperactive world, it’s easier than ever to connect […]
HCC Coding Services, a risk adjustment model that has been around for years, but has heightened visibility since Medicare Advantage Plans started to require RAF scores for reimbursement. Today ever commercial payer and coding leader is the eye for the same. Risk Adjustment – 101 The Risk Adjustment model uses a patient’s demographics which further […]
Getting onboard professionals to outsource medical billing services like MBC can dramatically streamline the workflow of your practice, further facilitating effective communication with your patients. Healthcare is constantly changing, with each year new coding rules and guidelines. It is practically impossible to learn and implement hence; outsourcing medical billing and coding services could be the […]
If you are trying to figure out between in-house Vs Outsource medical billing services; there are several considerations to take in. The present landscape for medical practices is a harsh one. Profitability isn’t near what it once was. In order to survive in today’s highly competitive climate your practice what is the best for your […]
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