Can Providers Waive Copays and Deductibles?

Healthcare service providers sometimes waive patient financial responsibility i.e., Copays and Deductibles as an accommodation to the patient, professional courtesy, and employee benefits. However, waiving co-pays and deductibles may violate fraud and abuse laws and payer contracts. For a payer, waiving co-pays and deductibles creates two problems. First, payers require co-pays to discourage overutilization and […]

Understanding 8-Minute Rule for Therapists

Introduction The therapy 8-minute rule is a vital concept for therapists, specifically in the context of billing Medicare or Medicaid for their services. This rule allows therapists to calculate the appropriate number of billable units based on the duration of direct contact therapeutic services provided to a patient. Therapists billing Medicare or Medicaid must also […]

Scope and Challenges for Teleneurology

Teleneurology Basics Teleneurology uses real-time or delayed communication between neurologists and patients or neurologists and other providers through shared audio, video, secure messaging, and other data exchanges. It has been an essential tool in improving the health and quality of life of those restricted to quality neurological care. These restrictions on care are often due […]

Understanding Anti-Markup Rule for Diagnostic Tests

Anti-Markup Rule The Anti-Markup Rule prohibits a billing physician or other supplier from marking up either the Technical Component (TC) or Professional Component (PC) of a diagnostic test ordered by the billing physician or other supplier (or ordered by a party related to such physician or other suppliers through common ownership or control) unless the […]

Surprise Billing: What Providers Must Know

Requirements Related to Surprise Billing Biden-Harris Administration, through the U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued ‘Requirements Related to Surprise Billing; Part I, ‘an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise […]

CPT Codes for Third Doses of COVID-19 Vaccine

The American Medical Association (AMA) on 16th August 2021 announced that the Current Procedural Terminology (CPT®) code set is ready for the rollout of third doses of the Pfizer and Moderna COVID-19 vaccines. The CPT Editorial Panel has expedited approval of a new administration code that is unique to a third dose of the current […]

Telehealth Billing Guidelines for Orthopedics

During the COVID-19 public health emergency, reimbursements for telehealth continue to evolve. The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. More Medicare Fee-for-Service (FFS) services are billable as telehealth during the COVID-19 public health emergency. In this blog, we shared telehealth billing guidelines for medical billing […]

Improving Point-of-Service (POS) Patient Collections

Increased Patient Financial Responsibility In the current healthcare climate, more and more patients are opting for high-deductible healthcare plans resulting in increased patient financial responsibility. Due to high deductible healthcare plans patients has to make large out-of-pocket payments to receive treatment. Few years before physician facilities, and hospitals were not that dependent on patient portions […]

Benefits of Outsourcing Oncology Medical Billing

By its very nature, oncology is one of the more stressful fields of medicine. Physicians are involved in scenarios dealing with life-threatening diseases and complex treatments every day. That means any other work apart from patient care will add stress. This includes administration and execution of oncology medical billing. Annual changes in medical coding, payer-specific billing […]

Eligibility Verification: Most Neglected Process of RCM

What is Eligibility and Benefits Verification? To receive payments for the services rendered, healthcare providers need to verify each patient’s eligibility and benefits before the patient’s visit. According to RemitData, two of the top five claim denial reasons for the year 2013 were insurance coverage related. With more patients choosing high deductible plans, this figure […]

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