Differentiating Between Medical Necessity and Medical Decision Making

Differentiating Between Medical Necessity and Medical Decision Making Medical coders and physicians often confuse between terms medical necessity and medical decision making and this confusion might lead to an inaccurate selection of Evaluation and Management (E/M) codes. It’s important to understand both concepts and clear the confusion as it could result in denied payments. Any […]

Why Are You Losing Money with ‘Insurance Only’ Billing?

What is ‘Insurance Only’ Billing? As the name suggests, in ‘Insurance Only’ billing, healthcare practices accept the amount the insurance company will pay and waive patient responsibility portions like co-pay, coinsurance, and deductible amounts. In most circumstances, this puts the physicians and the practices in jeopardy, especially when your client base is Medicare patients. Medicare […]

MBC: Best-in-Class Behavioral Health Billing Company

Behavioral health billing is quite challenging as various factors affect the billing process. The length of the session, the approach to therapy, and the willingness of the patient to partake make it far more difficult to standardize treatment and billing. Moreover, how insurance carriers look at behavioral health is noticeably unlike the way they look […]

Is Forming Group Practice is Correct Way for Me?

Forming group practice can be incredibly rewarding, from both a business and a financial standpoint. By starting a group practice, you have the opportunity to create a work atmosphere that allows healthcare providers to thrive, be cared for, and feel good about the work they do. Building, growing, and managing a group practice requires a […]

Staying Compliant by Auditing Medical Billing

Basics of Healthcare Audits In the healthcare space, audits play a crucial role in measuring compliance and patient satisfaction. There are two main types of healthcare audits that providers face, internal audits and external audits. External audits can be broken down further into government and commercial insurance audits. From there, government audits can be broken […]

Receiving Medicare Reimbursements with Modifier AT

Need for Active Treatment (AT) Modifier The Centers for Medicare & Medicaid Services (CMS) developed the Active Treatment (AT) modifier to define the difference between active treatment and maintenance treatment. Medicare only pays for active/corrective treatment to correct acute or chronic subluxation. Medicare never pays for maintenance therapy. In 2018, the Medicare Fee-for-Service program reported 41 […]

When Selling Your Practice, How to come up with a Profitable Formula?

It’s Hard to Sell Your Practice Selling a healthcare practice could be difficult a process. Key challenges in selling your practice include finding the right buyer, wading through legal and financial complications, and handling clinical matters. Coupled with a lack of knowledge about the process, some healthcare providers can be discouraged from selling their practice […]

Guidelines for Selection of Time-based E/M Codes

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Appropriate level of Evaluation and Management (E/M) services are based on Medical Decision Making (MDM) and time for services performed. In our previous article, we has a detailed discussion on how Medical Decision Making (MDM) affects E/M code selection and other factors involved. In this article, we will be focussing on guidelines for the selection […]

MPFS Strengthening Behavioral Health Billing for 2023

CY 2023 Medicare Physician Fee Schedule (MPFS) The Centers for Medicare and Medicaid Services (CMS) on Nov. 1, 2022, released the final 2023 Medicare Physician Fee Schedule (MPFS), addressing Medicare payment and quality provisions in the coming year. The U.S. Department of Health and Human Services (HHS) through its Centers for Medicare & Medicaid Services […]

Understand Split OB GYN Billing to Avoid Duplicate Billing

Challenges of OB-GYN Billing Coding and billing for maternity obstetrical care are quite different from the other medical specialties. Maternity care services typically include antepartum care, delivery services, and postpartum care. Depending on the patient’s circumstances and insurance carrier, the provider can either submit all rendered services for the entire nine months of services on […]

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