What you should know about Healthcare Provider Credentialing?

Healthcare provider credentialing involves many parties and all basic educational information. Healthcare providers all need to prove their education, skills, and training required to see patients. Simultaneously, healthcare oversight organizations monitor the work of medical providers to evaluate reports of improper care, among other matters. All these reporting and monitoring need to be checked periodically, […]

How can physicians secure data in the digital age?

Confidentiality is a pillar of the healthcare industry. The patients share their private information with physicians hence when deciding how to secure data in the digital age, clinicians must apply professional judgment and follow policies set forth by regulators. Electronic communication of patient information can facilitate clinical care, while mobile technologies and cloud computing boost […]

General Medical Billing Frauds in Healthcare Practices

Spending on healthcare in the US is intensive as healthcare spending grew 4.6 percent in 2019, reaching $3.8 trillion or $11,582 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 17.7 percent. However, an important fraction of this money – up to 10% of total health expenditure is wasted […]

Medicare Reimbursement for Orthopedic Surgery

The Centers for Medicare & Medicaid Services (CMS) sets reimbursement rates for Medicare providers and generally pays them according to approved guidelines such as the CMS Physician Fee Schedule. Medicare reimbursement for orthopedic surgery follows the same set of rules; however, recently the amount of Medicare reimbursement for orthopedic trauma surgery has fallen by nearly […]

Changed Role of Non-Physician Practitioners (NPPs) in Diagnostic Testing

Effective January 1, 2021, CMS permits Non-Physician Practitioners (NPPs) such as Nurse Practitioners (NPs) and Physician Assistants (PAs) to supervise diagnostic tests (including CIED management) only in states where it is allowed by state law and scope of practice. In all other states, only a physician can supervise diagnostic tests. Previously, CMS permitted non-physician practitioners […]

Coding for Subcutaneous Cardiac Rhythm Monitors

On Nov. 2, 2020, the American Medical Association (AMA) CPT® Editorial Panel announced the approval of a new Category III CPT® code to describe remote programming of subcutaneous cardiac rhythm monitors. The new code will be effective July 1, 2021. Please note that the existence of a Category III CPT® code does not guarantee payment. […]

What Providers can do to Prevent Claims from being Denied or Rejected?

Every healthcare provider has a complicated relationship with payers. Healthcare providers are busy in providing treatment to patients and they spend much time with patients and many of the time payers deny payments for the services provided. Providers can prevent claims denials and can ease the denial management that does not come so easy to […]

How to manage Orthopedic Bundled Payments?

In a bundled payments model, providers and/or healthcare organizations receive a single payment for all the services delivered during an episode of care. When it comes to Orthopedic Bundled Payments, these models are becoming more sophisticated and standardized with the help of analytic insights based on collected data from surgeons. CMS has made numerous changes […]

How to Set a Fee Schedule for Medical Practice?

How to Set Fee Schedule for Medical Practice?

Are you following an outdated fee schedule for medical practice and missing out on revenue? It is observed that many practices are suffering revenue losses because of their existing fee schedule and not knowing that fact that updating fee schedule for medical practice would improve their bottom line. After reading this blog you can easily […]

Key Opportunities in out-of-network Strategy for ASC

The beginning of the Patient Protection and Affordable Care Act resulted in millions of Americans becoming insured on plans with out-of-network benefits. Also, this act has narrowed insurance networks which left many providers completely out-of-network. Therefore, the out-of-network strategy for ASC is only revenue revenue-enhancing strategy for some ASCs. There are some key opportunities available […]

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