An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Types of APMs APMs: Meet the statutory definition of an APM. MIPS eligible clinicians participating in an APM are also subject […]
Pre-Diabetes Screening involves the testing of asymptomatic, high-risk individuals to assess whether they meet the criteria for either prediabetes or type 2 diabetes. Screening for prediabetes and diabetes is more frequently done in health care settings than in community settings. The process used to target and test patients may include a team approach, employing various […]
The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), under certain conditions. Becoming familiar with the Medicare DSMT reimbursement guidelines can help increase a DSMES service’s financial sustainability. Reimbursement guidelines change often, the Centers for Medicare & Medicaid Services resources listed below to ensure access to […]
Reference (Outside) Laboratory: When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding Modifier 90 to the usual procedure number. For the Medicare program, this modifier is used by independent clinical laboratories when referring tests to a reference laboratory for analysis. Modifier 90 […]
Healthcare Revenue Cycle Management Healthcare Revenue Cycle Management professionals use information technology to track claims throughout their lifecycle. This is necessary to ensure payments are collected and denied claims are addressed. However, some hospitals struggle to implement information technology and billing infrastructure that successfully manages claims and large outpatient networks. Effective health information technology is […]
Creating medical billing reports can help you diagnose the health of your practice. Reports can show you how your practice is performing on important revenue cycle metrics, whether claims are being paid in a timely fashion and how well insurance carriers are paying you for key procedures, among other things. These reports will provide you […]
As a physician, you need a reliable and efficient business intelligence system that provides automated revenue reports of your practice. These reports will provide you with accurate information regarding the health of your practice saving you from lost revenue, keeping your practice financially sound while allowing you to free up your clinical staff and resources […]
As we all know, in the current age of the internet, having a website for your practice is a must. But if your website is not properly optimized then you would fall behind the competition. SEO stands for ‘search engine optimization. It is the process of getting organic traffic from search engines. In other words, […]
A rejected claim contains one or more errors found before the claim was processed. Errors will prevent the insurance company from paying and the rejected claim is returned to the biller to be corrected. A rejected claim may be the result of a clerical error or a mismatched procedure and an ICD code. A rejected […]
The revenue cycle process and its management have continuously progressed over the last few years to keep up with the changes occurring in the healthcare industry. 2020 is no exception. When we talk about healthcare units and hospitals, the primary thought that comes to one’s mind is the patient care experience as it relates to […]
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