Medical practices sometimes equate improper payments with medical billing fraud. Improper payments could be unintentional where your received payment even after not meeting program requirements. While medical billing frauds are intentional where practices might through up-coding and unbundling try to receive more insurance reimbursements than allowed. For differentiating between improper payments and medical billing fraud, let’s […]
Differentiating Between Improper Payments and Medical Billing Fraud
Read More.. Differentiating Between Improper Payments and Medical Billing Fraud
Administration Expanding Access to Healthcare in 2024
Strengthening Affordable Care Act (ACA) Recently, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality healthcare options for millions of consumers. This proposed rule would increase […]
Billing by Non-Physician Providers (NPPs)
A non-physician provider (NPP) is a healthcare provider who is not a physician but who practices in collaboration with or under the supervision of a physician. NPPs may bill payers directly, rather than billing under a physician, in certain circumstances. Examples of NPPs include physician assistants (PAs); advanced practice registered nurses (APRNs); nurse practitioners (NPs); […]
General Coding Guidelines for ICD-10-CM
ICD-10-CM Basics Selecting accurate diagnosis codes using ICD-10-CM is challenging due to the availability of more than 68,000 codes. In this article, we shared general coding guidelines for ICD-10-CM which will help you in selecting accurate diagnosis codes. Before we proceed with coding guidelines, you’ll need access to two sets of lists in ICD-10 CM […]
MBC can help in Prioritizing the Patient Experience
Significance of Patient Experience There is no question that patient experience is a huge factor when it comes to the success of your practice. In case of negative patient experience, their word-of-mouth can adversely impact future patients as well as their willingness to pay bills in a timely manner. The patient experience begins as soon […]
Understanding of No Surprises Act & Good Faith Estimates for 2023 Billing
Basics of No Surprises Act The No Surprises Act went into effect on January 1, 2022. This Act is aimed at reducing ‘surprise bills’ to patients in the context of services provided at hospitals and ambulatory surgical centers and includes requirements for hospitals and ambulatory surgical centers, as well as physicians providing services at such […]
Understanding Cataract Co-Management Billing
Billing and coding for cataract co-management can be tricky. It’s important that all parties involved should get accurately reimbursed for their time and expertise. To explain cataract co-management billing, we discussed everything starting from defining co-management; the relationship between involved parties; required forms to be filled; CPT codes and modifiers; and key boxes in the […]
Guidelines for Billing Medicare for Ambulance Transportation
Medicare Coverage for Ambulance Transportation Medicare Part B covers emergency ambulance services and, in limited cases, non-emergency ambulance services. Part B covers medically necessary emergency and non-emergency ambulance services at 80% of the Medicare-approved amount. In most cases, you pay a 20% coinsurance after you meet your Part B deductible ($233 in 2022). All ambulance […]
Billing Medicare for Initial Preventive Physical Examination
Initial Preventive Physical Examination (IPPE) The initial preventive physical examination (IPPE) is a preventive visit also known as a ‘Welcome to Medicare Preventive Visit’. Medicare pays for one IPPE per beneficiary per lifetime for beneficiaries within the first 12 months of the effective date of the beneficiary’s first Part B coverage period. The IPPE may […]
Surgical Package Coding Guidelines
Most medical and surgical procedures include pre-procedure, intra-procedure, and post-procedure work. When multiple procedures are performed at the same patient encounter, there is often an overlap of the pre-procedure and post-procedure work. Payment methodologies for surgical procedures account for the overlap of the pre-procedure and post-procedure work. The component elements of the pre-procedure and post-procedure […]