CMS Proposed a Rule for Improving Prior Authorizations

CMS recently proposed a rule to improve prior authorization processes by reducing the burden on providers and patients. This proposed rule would place new requirements on Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs, and Qualified Health Plans (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of […]

Credentialing Procedure for Adding New Provider

To bill, any healthcare service to an insurance carrier, the provider, or the health organization should be credentialed by that insurance carrier. Provider credentialing is one of the most important processes of practice management. In provider credentialing, you are enrolled in the insurance carrier’s network and get authorized to render services to the patients who […]

Beginners Guide for Billing Therapy Care

Orthopedic surgeons are increasingly incorporating physical and occupational therapy services into their practices. In-house billers, who may be inexperienced with the new services, terminology, and associated CPT codes, may be unsure about billing for therapy care. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. We keep on […]

Avoiding Common Provider Credentialing Mistakes

In the healthcare sector, maintaining standards is essential to ensure high-quality medical care is provided to patients. There is no room for treatment errors and costs remain optimum; that’s why credentialing is crucial. Credentialing is a quality assertion process among medical practitioners to bring down the incidence of medical errors. Provider credentialing involves a thorough […]

Medicare Coverage for Cognitive Assessment and Care Plan

January 1, 2017, onwards Medicare provided coverage for cognitive assessment and care plan services. Reimbursement requires cognition-focused evaluation, identification of caregivers and caregiver needs, and development, revision, or review of an Advance Care Plan. Effective January 1, 2022, Medicare increased payment for these services to $282 (it will get geographically adjusted) when provided in an […]

Billing for Transitional Care Management

Many practitioners have difficulty being paid for Transitional Care Management (TCM) services. In many cases, claims submitted for TCM services have not been paid due to several common errors in claim submission. In particular, the practitioner should ensure that the entire 30-day TCM service was furnished, the service began with a qualified discharge from a […]

Avoiding Misuse of Common Modifiers

One of the common reasons medical claims may be denied is for missing modifiers or invalid modifier combinations. Accurate coding of treatment is essential, but it’s also important to ensure you include modifiers when necessary and ensure you’ve used the correct one for the code you’re using. When your claim is denied, it not only […]

RCM Strategies to Improve Practice Revenue

Your medical practice revenue is driven, impacted, and influenced by Revenue Cycle Management (RCM) strategies. It includes claims management, patient payments, and your in-house billing workflow. Without implementing these strategies, providers might find it difficult to maintain high levels of clean claims, adjust to an increasing dependence on patient payments, or manage their billing effectively. […]

Avoiding Coding Audits

Government and private payers conduct audits to find out fraudulent or abusive medical billing practices. As a provider, you deserve to be paid accurately for the medical care you provide. At the same time, it’s essential that you avoid improper billing practices to steer clear of trouble and maintain a flourishing practice. In this article, […]

Managing Medical Records while Closing or Relocating Practice

The decision to close or relocate a medical practice can be a difficult one, with consequences for patients as well as for the departing physician’s colleagues. Physician practices close or relocate for many reasons, including practice solo, joining another group, relocating, a decision to sell, retire, physician illness, due to the COVID-19 pandemic. Whether you […]

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