Targeted Probe and Educate (TPE) is the process that a Medicare Administrative Contractor (MAC) can utilize when providers are selected by Medical Review. The TPE review process may include up to three rounds of a prepayment or post-payment probe review with education. CMS’s Targeted Probe and Educate (TPE) program is designed to help providers and […]
CMS is proposing changes to the Medicare Shared Savings Program (Shared Savings Program) quality performance standard and quality reporting requirements for performance years beginning on January 1, 2021, to align with Meaningful Measures, reduce reporting burden and specialize in patient outcomes. For the performance year 2020, CMS is proposing to share automatic full credit for […]
HRSA Uninsured COVID-19 Program The COVID-19 Uninsured Program portal is opened by HRSA. Providers who have conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020, can start to file claims for reimbursement for testing and treating the uninsured. As part of the FFCRA, PPPHCEA, and […]
The American Hospital Association (AHA) is calling on CMS to re-evaluate payment options for hospitals that accepted accelerated Medicare payments at the early stage of the COVID-19 pandemic. The hospital group requested CMS Administrator Seema Verma to allow all hospitals to elect to receive periodic interim payments (PIP) or accelerated payments, per initial CMS communications […]
Following a single hospital encounter, patients often receive multiple bills from a variety of providers. Sometimes these bills are from more than 20, depending upon services provided and how many specialists are involved. Nowadays, patients are becoming more engaged in making healthcare decisions and managing their cost of care. The protection or promotion of the […]
Physicians always wish to get reimbursement in the first attempt. To get the reimbursement in the first attempt providers need to eliminate some repetitive errors. This can happen if the provider or their hired staff for billing can read EOB or ERA interpret correctly and understand. There is always some percentage of getting claims denied. […]
2020 began with many significant billing and coding updates for family physicians. A study found that Family physicians could not bill for all the services provided in the majority of their visits because CPT codes for medical billing did not cover the services, a study found. Family practice medical billing services ensure providers do not […]
COVID-19 pandemic will have lasting financial loss effects on healthcare providers, but leveraging some of the capabilities developed to adjust and continuously provide service to patients during this pandemic can build more strong and smooth revenue cycle management for the healthcare industry. Telehealth is one of the biggest changes that came out of the pandemic […]
The CMS (Centers for Medicare and Medicaid Services) and CDC (Centers for Disease Control and Prevention) recently announced provider reimbursement update available to physicians and health care providers to counsel patients, at the time of coronavirus disease 2019 (COVID-19) testing. Providers educate patients about the importance of self-isolation once they are tested and prior to […]
COVID-19 massively affected US health care. The American Hospital Association estimates that American hospitals incurred more than $202 billion in losses between March 1st and June 30th. Medical billing is also affected due to COVID-19. According to healthcare lawyer Delphine O’Rourke, clinical documentation is critical to serving patients with COVID-19 but also avoiding medical billing […]
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