Understanding External Payer Audits An external payer audit is an examination of a healthcare practice’s finances or processes conducted at the will of payers. These payers are either the government or a commercial insurance company looking to ensure correct payments were provided to the practices for past cases. Government audits can be broken down even […]
Con artists can try to get your patients’ Medicare Numbers or personal information so they can steal their identity and commit Medicare fraud. Medicare fraud results in higher health care costs and taxes for everyone. So, you will have to take care of all HIPAA compliances. Whether you have outsourced medical billing or hired staff […]
The medical audit is the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patient’.The audit is a continuous cycle involving observing practice, setting standards, comparing practice with standards, implementing change, and observing […]
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 […]
Today, the majority of deaths worldwide are due to four noncommunicable diseases such as cancer, cardiovascular disease, type 2 diabetes, and respiratory diseases; most of these deaths are potentially preventable. Four sets of behaviors contribute to the high and growing burden of noncommunicable disease: consumption of tobacco, alcohol, and highly processed foods, as well as […]
There are patients who are angry, disrespectful, and rude; basically difficult patients who demand specific drugs or tests, even when they’re not indicated; and patients who growl at everyone, act suggestively to the nurses, or ask you to submit a fraudulent bill so the insurer will cover the cost of treatment. Taking steps to Implement […]
Not to be confused with traditional ideas of patient care, patient-centered care pushes the boundary of healthcare to create systems and processes that are truly custom-made to enhance the health, well being, and treatment plans for both health professionals and patients. Recently, the Mountain State Healthcare Alliance (MSHA) received the 2012 National Healthcare Award from […]
With a fleet of changes in ICD-10 and updates, 2018 can be a troublesome year for orthopedic practitioners. If your ICD-10 orthopedic coding is not up to the mark, you are likely to suffer on the reimbursement front. Most of the changes in CPT 2018 have been made to the Musculoskeletal System codes (20005-29999) and […]
The first thing any patient comes and sees in your office is the front desk. They have a simple superpower to make your practice profitable and i.e. through patient scheduling. Your Front desk ensures that all your patients coming to the practice see a smooth flowing schedule and get the required customer service. Your front […]
It has become imperative in this ever-changing healthcare environment to focus on a medical billing practice’s financial health. In the case of small and medium-sized practices, ancillary services are added, but the best way to increase revenue is by focusing on efficiency. Some Billing Suggestions For Medium-Sized Practices Are: Patient Collections: This must be a […]
