There are a number of ways in which health insurance carriers provide coverage. Health Care plans insurance coverage can be quite complex, as it involves the coordination between a healthcare provider, the health insurance provider, and the actual person receiving care. Some of the methods of coverage include managed care, indemnity policies, and high-deductible plans. […]
Just like when you bill to the private third-party payer, billers must send claims to Medicare and Medicaid. These claims are very similar to the claims you’d send to a private third-party payer, with a few notable exceptions. When you claim for Medicare and Medicaid, there is no need to go through a clearinghouse for […]
The pressure on hospitals to improve patient care at lower costs is not new—and it’s not going away. Technology has never been more of a priority than it is right now for healthcare providers, especially as the industry continues to shift from fee-for-service to value-based care models. Hospital leaders are juggling a growing slate of […]
Cancer patients admitted to an emergency or intensive care unit (ICU) have some critical requirement of basic care needs because of their unknown illness; time-point in the treatment plan and treatment-related deadliness resulting in organ damage, hemodynamic infection, or blood contamination. Over the past two decades, therapeutic advances have reshaped not just the medical approach […]
CMS released the proposed Outpatient Prospective Payment System – OPPS rule for 2018— which includes a major proposed cut for separately payable drugs purchased under the 340B program. The proposal would reduce reimbursement for separately payable Medicare Part B drugs purchased at 340B prices. Reimbursement would drop from average sales price plus 6% to ASP […]
The Center for Medicare and Medicaid Services (CMS) proposed a new rule that will update the payment policies and rates. The update will specifically cater to Hospital Outpatient and Ambulatory Surgical Centers (ASC). The rules will set forth a motion to promote efficient service and promote higher quality service for all the Medicare beneficiaries. The […]
A large Home Medical Equipment (HME) billing service provider is looking to aggressively expand its RCM business. In the business world as well as in the healthcare field growth is good. However, with growth comes a unique challenge; which may or may not be solved. Even though evolving or growing medical facility services may not […]
Medical Coding is more complicated today with different overviews regarding medical codes according to the insurance companies. The documentation and coding for diagnoses/procedures are becoming a one-sided question of the medical billing. Mistakes to avoid while coding for preventive medicine services “You’re given codes are incorrect and can please check them or EOB with wrong codes […]
The discharge process remains a major challenge for payer who wants to improve outcomes and reduce readmissions, in large part because patients often don’t understand the instructions. Recent research suggests that implementing follow-up care strategies can improve the process; including treating it more like the admissions process and dispensing medications at that point. Today’s hospitals […]
Managing a chiropractic facility and chiropractic billing and coding is a complicated undertaking. It stands especially vital when you factor in the ever-changing requirements and regulations of having to do with health insurance and federal/state government programs. A modernized and efficient financial process is crucial for any successful practice and is a key to a […]
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