Many times, a service is not medically necessary, hence denied coverage by Medicare. This leaves physicians feeling the pinch of lower reimbursements thereby a loss of revenue. Therefore, CMS worked out a solution, revised rules, and has given ABN top precedence. In situations where Medicare could deny reimbursements, the patient is sent an ABN to […]
The changing healthcare landscape is impacting pharmacists in the US to face new challenges and look for innovative ways to create an effective and efficient pharmacy system. This ebook titled Pharmacists: Challenges, Strategies, Effective Guidelines & Processes, is an excellent compilation of the challenges being faced by pharmacists and the strategies that have been introduced […]
Air Ambulance services are usually furnished to those beneficiaries who need immediate medical attention, and where other means of transportation are not probable. An air ambulance service includes fixed (aircraft) and rotary (helicopter) wing services and are used mostly in emergency situations. Insurance payers generally do cover air ambulance services; only if certain terms and […]
Patients and Ambulatory Surgical Centers both, in the past and present, have been exposed to a bad experience as far as following the proper billing guidelines are concerned. From both ways, the suffering has been equal; more so for the ASCs as not having a genuine physician and ASC billing facility has hampered the growth […]
DME is any equipment that provides therapeutic benefits to a member because of certain medical conditions and/or illnesses that can withstand repeated use, is primarily and customarily used to serve a medical purpose, and is appropriate for use in the home. Rules revolving DME billing given the two major categories-purchase and renting DME, accompanied by […]
There is a growing need for a pharmacist to play the supporting role of a patient-care provider which is targeted towards medication use and its cost-effective delivery i.e. medication therapy management (MTM). This comprises medication management, educating the patient, and preventive care, along with building an understanding of medication. Clinical pharmacists work collectively with nurses […]
Also known as ambulance or paramedic services, Emergency Medical Services (EMS/EMAS/EMARS) is the service used in case of an immediate medical requirement. It is especially dedicated to providing out-of-hospital acute medical care and providing transport to patients who are critically injured or ill and cannot transport themselves. These services are also known as ambulance/emergency/rescue/first-aid or […]
It is important for practices, including Optometry, to ensure the submission of clean claims for capturing and increasing timely revenues by identifying the causes for non-payment. It is essential that the staff is well-trained and possesses thorough knowledge of the billing and coding procedures of the Optometry practice. According to hmsa.com, A clean claim is […]
Ambulatory Surgical Centers (ASCs) cater to patients who need medically essential surgeries but do not require an overnight stay at a hospital. The following are certain frequently asked ASC Billing Questions arena: 7 Frequently Asked ASC Billing Questions 1. Which is the top information systems management for ASCs? A couple of models used for ASCs […]
The US healthcare is evolving. To improve pharmacy Revenue the pharmacies need to be equipped with a better billing system. Here are some challenges faced by pharmacies that cause billing errors and affect customer relations, revenues, and reimbursements: Access to the patient’s eligibility at the time of service may be unavailable. The staff may not be […]
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