Avoiding Fraudulent Billing as a New Medical Practice

As a healthcare provider, during your residency, you probably are not focused on who pays for your patients’ care. Once you start practicing, it is important to understand who the payers are. The U.S. health care system relies heavily on third-party payers, and, therefore, your patients often are not the ones who pay most of […]


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Surprise Medical Billing for Anesthesiologists

Basics of Surprise Medical Billing Out-of-network billing, or ‘surprise medical billing,’ occurs when a patient receives a bill for the difference between the out-of-network provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductibles. These bills can be unanticipated by patients, who often assume that facility-based providers, including anesthesiologists, are […]


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Basics of EDI Enrollment with Medicare FFS

What is EDI Enrollment? For a provider is trying to enroll with Medicare FFS, they must first establish an Electronic Data Interchange (EDI) agreement with Medicare. EDI is the process of using nationally established standards to exchange electronic information between business entities. The Department of Health and Human Services (HHS) adopted certain electronic standards for […]


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Removal of Temporary Emergency Waivers for Nursing Home

During the Public Health Emergency (PHE), The Centers for Medicare & Medicaid Services (CMS) used a combination of emergency waivers, regulations, and sub-regulatory guidance to offer health care providers the flexibility needed to respond to the pandemic. In certain cases, these flexibilities suspended requirements in order to address acute and extraordinary circumstances. Now, CMS is […]


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CPT Codes for Digital E/M Service

In the 2020 CPT codes set, CMS six released new codes to report online digital evaluation services or e-visits. The codes describe patient-initiated digital communications provided by physicians or other qualified health professionals, codes are 99421, 99422, and 99423. Three others who describe similar interactions when they involve a nonphysician health professional are 98970, 98971, […]


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Increased Importance of Telehealth in Small Practices

Increased Importance of Telehealth Small practices tried their best to survive during the COVID-19 pandemic and telehealth helped them a lot to survive in these challenging times. During the COVID-19 pandemic, the use of telemedicine has only grown in importance. Experts predict that by 2025, the size of the telehealth market will reach $17.2 billion. […]


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Providing Non-Essential Services Using Virtual Care

In March of 2020, the CDC asked physicians to provide non-essential care with virtual care in order to reduce the risk of COVID-19 exposure. But now post-pandemic landscape, many physicians have adopted virtual solutions in order to provide quality care for marginally healthy groups. Virtual care gives physicians risk-free, reliable ways to offer non-essential care […]


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Benchmarking Financial Performance of Radiology Practices

Benchmarking involves comparing business statistics to historical data or to the same type of data gathered across a wider spectrum. This is only one statistic, or metric, that can be used to evaluate a practice’s performance. In addition to physician productivity, practices often measure their quality of service and financial performance against internal goals or […]


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Highly Neglected Revenue Cycle Processes

For most providers, the revenue cycle process means submitting claims and wait for payer reimbursements. These providers are under the impression that if they submit the claim, it will get paid but that’s not the case. Revenue cycle management includes really crucial processes like provider credentialing and contracting, Benefits verifications, prior authorizations, and out-of-network billing […]


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