Recently CMS published Medicare Fee-for-Service (FFS) improper payment date for ambulance services for the 2020 reporting period. For this reporting period, the improper payment rate for ambulance services was 7.2 percent, with a projected improper payment amount of $349 million. As per the findings, insufficient documentation accounted for 62.5 percent of improper payments for ambulance […]
Revised Role of Prior Authorization So far insurance carriers have been using prior authorization as a tool to control spending and promote cost-effective care. But in changing billing scenarios role of prior authorizations has changed drastically. There is little information about how often prior authorization is used and for what treatments, how often authorization is […]
Increasing Claim Denials Recently Kaiser Family Foundation published an analysis of claim denials for various marketplace payers for the year 2020. Under the Affordable Care Act, marketplace payers need to report claims denial data and this analysis used the same data to understand claim denial status. The analysis found that, overall, nearly one out of […]
As a practice owner, you might have a team of professional physicians who possess the right qualifications and licenses but without properly credentialed providers you invite the risk of losing payments. To enhance the performance of your practice you must complete the entire credentialing process including collecting provider documentation & validation; identifying top payers; applying […]
Coding guidelines can be seen as a sort of general best practice for the coding profession. Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective […]
Medicare Physician Fee Schedule Proposed Rule CMS covers Opioid Treatment Programs through bundled payments for opioid use disorder treatment services in an episode of care provided to people with Medicare Part B. Recently on July 7, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces the proposed policy changes […]
CY 2023 Medicare Physician Fee Schedule Proposed Rule On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, […]
Billing Part B Outpatient Therapy Services Outpatient rehabilitation therapy includes Physical Therapy (PT), Occupational Therapy (OT), and Speech-Language Pathology (SLP) services. Medicare covers outpatient PT, OT, and SLP services when: A physician or Non-Physician Practitioner (NPP) certifies the “treatment plan,” called the Plan of Care (POC), ensuring: A patient needs therapy services POC is: Established […]
SNF Advanced Beneficiary Notice of Non-coverage Medicare requires SNFs to issue the SNF Advanced Beneficiary Notice of Non-coverage to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is not medically reasonable and necessary; or considered custodial. The […]
Primary Care Physicians are Leaving Money on the Table According to a recent study published in the Annals of Internal Medicine, primary care physicians left much money on the table for services provided but not coded and billed. This research estimates that a single primary care physician could add $124,435 in preventative services to their […]
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