Value-Based Care Vs Fee-for-Service

As healthcare regulations change, so do healthcare provider reimbursement models. Understanding different forms of reimbursement and their advantages and disadvantages can help you better figure out your healthcare organization’s revenue cycle management. The two main models between which the American healthcare network has been fluctuating are fee-for-service (FFS) and value-based care (VBC). Fee-For-Service In the […]

Expansion of Medicare Reimbursement for Home Dialysis

The Centers for Medicare & Medicaid Services (CMS) on 2nd October 2020, finalized policies that allow certain new and innovative equipment and supplies used for dialysis treatment of patients with End-Stage Renal Disease (ESRD) in the home to qualify for an additional Medicare payment. This final rule encourages the development of new and innovative home […]

Defining ‘Reasonable and Necessary’ Coverage for Medicare

Medicare won’t provide coverage for items and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury. National coverage determinations (NCDs) are made through an evidence-based process, with opportunities for public participation. In the absence of NCDs, an item or service may be covered at the discretion of […]

Clinical Documentation: Great Way to Improve Coding

Medical documentation and coding are bricks and mortar of the medical billing process. In the past 25-30 years, we seen the increased importance of documentation and coding. Compliant clinical documentation and coding are essential to every healthcare setting, no matter the individual responsible for and/or performing the tasks. We need to ensure medical necessity is […]

Streamlining and Automating Prior Authorization

CMS’s Proposed Rule on Automating Prior Authorization On 10th December 2020, The Centers for Medicare & Medicaid Services (CMS) proposed a new regulation aimed at improving the sharing of healthcare data between payers and providers and streamlining, a major administrative hassle for providers. This new rule will boost patient data exchange and streamline which will […]

What is the Medicare Crossover Claim?

A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and/or coinsurance. A Coordination of Benefits Contractor (COBC) is used to electronically, automatically cross over claims billed to Medicaid for eligible recipients. […]

Outpatient E/M Revisions for 2021

The American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) has announced guideline and code descriptor changes for outpatient E/M services to be effective from Jan. 1, 2021. These changes will be applicable only to office or other outpatient E/M codes (99202-99215); all other E/M services will remain unchanged. Till the year […]

Coding for Open Fracture Debridement

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Basics of Open Fracture Debridement Debridement is used to remove foreign material or damaged, dead, or contaminated tissue from a surgical field, wound, or injury. Debridement is used to promote healthy healing of damaged skin, tissue, muscle, or bone. The debridement of small amounts of devitalized or granulation tissue during a surgical procedure is typically […]

How to Credential Your Practice with Vision Plan?

You just graduated from a school of optometry and decided on your practice location. If you Vision plan on examining patients who wish to use their vision and medical insurance, you must be an ‘in-network provider’ with that insurance company. According to the US Census Bureau, over 83 percent of the US population has health […]

Most Popular Payers to Get Credentialed with

Credentialing has become crucial for medical practices to survive in an increasingly volatile and competitive industry. Most American citizens today are covered by an insurance plan provided by some company or the other. If you fail to get credentialed with the insurance companies, then you will lose clients to your competitors. Hence, having the knowledge […]

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