Medicare, Medicaid, and private payers had relaxed their billing guidelines and revised reimbursement policies so that physicians can provide better care during the COVID-19 pandemic. A Public Health Emergency (PHE) was declared for the same by the federal government. In March 2020, a public health emergency (PHE) declaration was issued under Section 201 of the […]
Most practices are struggling to stay afloat due to shrinking reimbursements and the recent impact of the COVID-19 pandemic. The days of submitting an insurance claim and getting paid within 30 days are long gone. Various payer billing guidelines and reimbursement policies after the end of the Public Health Emergency (PHE) make it really difficult […]
On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) published a final rule which was implemented on February 28, 2022. This final rule addressed the classification and payment of continuous glucose monitor (CGMs) under the Medicare Part B benefit for durable medical equipment (DME). This rule expanded the classification of DME to […]
Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit. In order for a beneficiary’s DME to be eligible for reimbursement, the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination (LCD) must be met. In addition, there are specific statutory payment […]
On 7th April 2022, in response to the COVID-19 PHE and under section 1135 of the Social Security Act, CMS passed several temporary emergency declaration blanket waivers which were intended to provide health care providers with extra flexibilities required to respond to the COVID-19 pandemic. While the waivers of regulatory requirements have provided flexibility in […]
The Centers for Medicare & Medicaid Services (CMS) every year releases the Medicare Physician Fee Schedule (MPFS) to announce policy changes. In this blog, we shared important coding updates for the year 2022, applicable to urgent care services. Reduced Conversion Factor The Protecting Medicare and American Farmers from Sequester Cuts Act were signed into law […]
Documentation of medical services is necessary to provide information to assist health care professionals in providing services to patients which are medically necessary. Apart from helping in medical billing and coding, it also reflects the competency and character of the physician. Even though the role played by documentation has always been a supportive one, it’s […]
Electronic Data Interchange (EDI) represents a digital communication channel to deliver data from payers to providers digitally and securely. Most of the providers have a lot of confusion over what it meant by EDI or ERA enrollment. EDI simplifies the process of sending information back and forth between provider and insurance carrier. If you want […]
When you submit a claim to any insurance carrier, it will either get paid, fully or partially, or it might get rejected or it might get denied. Most of the time, providers get confused between claim rejection and claim denial. When a claim is rejected, it generally means details mentioned in the claim are either […]
Providers continue to wonder how we can live in a world where so many RCM processes are handled quickly with technology, yet decisions that affect patient health are slowed by faxes and bureaucracy, even when there is only one clear treatment option. Yes, you are right, we are talking about Prior Authorization (PA) or Pre-Auth. […]
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