Defining ‘Separate Procedures’ According to CPT® surgery guidelines, some of the procedures or services listed in the CPT® codebook that are commonly carried out as an integral component of total service or procedure have been identified by the inclusion of the term ‘separate procedure.’ The CPT codes designated as ‘separate procedure’ should not be reported […]
What is Value-Based Care? Unlike traditional ‘fee-for-service care models that link payment to the number and type of services utilized, value-based healthcare is a healthcare delivery model in which providers, including hospitals and physicians, are paid based on patient health outcomes. Value-based care differs from a fee-for-service or capitated approach, in which providers are paid […]
In line with the Obama Administration’s efforts to provide high-quality care while reducing costs, in April 2016 CMS announced an initiative to implement bundled payments for hip and knee replacement surgeries, called Comprehensive Care for Joint Replacement (CCJR). Recently in May 2021 CMS published an 81-page final rule to extend and change the Comprehensive Care […]
Providers face multiple healthcare fraud and abuse laws at the local, state, and federal levels. Fraud and abuse cases in the healthcare industry cost billions of dollars a year. Healthcare fraud and abuse situations include submitting false claims; billing for medically unnecessary services; billing and coding errors; billing for services that were provided by unlicensed […]
The first element of the revenue cycle starts with patient registration. From the minute a new patient begins the registration process, it’s crucial that you are asking for and receiving correct information. If any information is omitted, given incorrectly, or entered incorrectly by the front desk then it will lead to incomplete and/or incorrect claim […]
Healthcare service providers sometimes waive patient financial responsibility i.e., Copays and Deductibles as an accommodation to the patient, professional courtesy, and employee benefits. However, waiving co-pays and deductibles may violate fraud and abuse laws and payer contracts. For a payer, waiving co-pays and deductibles creates two problems. First, payers require co-pays to discourage overutilization and […]
Introduction The therapy 8-minute rule is a vital concept for therapists, specifically in the context of billing Medicare or Medicaid for their services. This rule allows therapists to calculate the appropriate number of billable units based on the duration of direct contact therapeutic services provided to a patient. Therapists billing Medicare or Medicaid must also […]
Teleneurology Basics Teleneurology uses real-time or delayed communication between neurologists and patients or neurologists and other providers through shared audio, video, secure messaging, and other data exchanges. It has been an essential tool in improving the health and quality of life of those restricted to quality neurological care. These restrictions on care are often due […]
Anti-Markup Rule The Anti-Markup Rule prohibits a billing physician or other supplier from marking up either the Technical Component (TC) or Professional Component (PC) of a diagnostic test ordered by the billing physician or other supplier (or ordered by a party related to such physician or other suppliers through common ownership or control) unless the […]
Requirements Related to Surprise Billing Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued ‘Requirements Related to Surprise Billing; Part I, ‘an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise […]
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