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, and comparing practice with standards, implementing change, and […]
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 […]
Revenue cycle management (RCM) is the commercial process that uses medical billing software, which healthcare facilities use to track patient care episodes from registration and appointment scheduling to the final payment of a balance. In simple terms, it refers to the process of tracking the payments for the services rendered at a provider’s office, from […]
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 […]
Like other healthcare specialties, family practice billing also depends upon apposite and timely documentation and communication with patients and insurance payers. The doctor’s office starts the process by serving a patient and documenting the normal SOAP notes. Next, the medical coder translates the visit into the appropriate numerical codes that allow for easier communication with […]
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 […]
It’s not rocket science to know that dermatology is one of the most difficult and complex medical specialties when it comes to medical billing and coding. Elements like global procedure periods, bundled procedures, and particularly modifiers – all contribute to a multifaceted coding environment that leads to errors and one which eventually ends with claims […]
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 […]