How to Avoid Common Medical Billing Compliance Pitfalls?

There are several major issues facing compliance officers today, such as HIPAA, Stark Law, and Anti-kickback Statute issues, as well as many billing compliance issues. Billing issues continue to appear in federal government False Claims Act settlement agreements and government audit reports. Here, we’ll discuss incident-to and shared billing compliance pitfalls and focus on what […]


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Prior Authorization and It’s Impact on Practice Collection

Prior authorization is a check run by some insurance companies or third-party payers before they will agree to cover certain prescribed medications or medical procedures. There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. A failed authorization […]


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How to Manage Incoming Calls at Your Medical Practice?

Medical Practice complains about the volume of incoming telephone calls and how much time their employees spend handling them. Why is your Medical Practice getting so many calls? It is the only way patients can make or change appointments. Patients call the office for refill authorization. Patients were distracted during their visits and are calling […]


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Wound Care Billing Guidelines 2019

Not only is wound coding and documentation is a daunting task, but also attracts intense inspection from auditors, with severe financial penalties for mistakes. And it’s only gotten more challenging with the new ICD-10 changes. What is included in the wound care billing guidelines 2019? An infected surgical wound, T81.4xxA, is among those 51 codes […]


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What Are The Differences – an Interventional Cardiologist and Invasive, Non-Interventional Cardiologists?

A healthy heart is essential to lead a healthy and happy lifestyle. There are a lot of things that can go wrong with your heart, and sometimes the symptoms that something is wrong are not always obvious. A cardiologist is a health practitioner who specializes in diagnosing problems with the heart and surrounding arteries. What […]


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Reimbursement Methods: Fee-For-Service vs Capitation

As the present USA healthcare trends focusing more on Reimbursement Methods like value-based care, the fee-for-service is under intense scrutiny. Often labeled as an antiquated payment model, it promoted over-utilization by physicians and patients, while creating fragmentation among healthcare service providers. The Affordable Care Act of 2010, along with MACRA legislation in the year 2015, […]


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How To Deal With Auditing Issues In Cardiology Documentation?

Auditing season is heating up; cardiology practices with documentation concerns are contacting medical auditors to review their clinical documentation improvement (CDI) policies so they are secure in their practices to avoid documentation issues that can lead to negative payer audits. In medical practices, it is so important to have coders, billers, and knowledgeable clinical staff […]


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How You Can Contribute To Claim Denial Management Process?

Denials tend to evoke frustration and a loss of motivation to work. Hence it is essential that strategies are designed to manage the denial management process effectively and use it to improve the revenues of medical practice. The claim denial management process is one of the most vital aspects of a revenue cycle management process. […]


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