outsourced medical billing services

Changes to the Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service – FFS) beneficiaries in situations where Medicare payment is expected to be denied. Skilled nursing facilities (SNFs) issue the ABN to transfer […]

Targeted Probe and Educate (TPE) is the process that a Medicare Administrative Contractor (MAC) can utilize when providers are selected by Medical Review. The TPE review process may include up to three rounds of a prepayment or post-payment probe review with education. CMS’s Targeted Probe and Educate (TPE) program is designed to help providers and […]

CMS is proposing changes to the Medicare Shared Savings Program (Shared Savings Program) quality performance standard and quality reporting requirements for performance years beginning on January 1, 2021, to align with Meaningful Measures, reduce reporting burden and specialize in patient outcomes. For the performance year 2020, CMS is proposing to share automatic full credit for […]

HRSA Uninsured COVID-19 Program The COVID-19 Uninsured Program portal is opened by HRSA. Providers who have conducted COVID-19 testing or provided treatment for uninsured individuals with a COVID-19 diagnosis on or after February 4, 2020, can start to file claims for reimbursement for testing and treating the uninsured. As part of the FFCRA, PPPHCEA, and […]

Following a single hospital encounter, patients often receive multiple bills from a variety of providers. Sometimes these bills are from more than 20, depending upon services provided and how many specialists are involved. Nowadays, patients are becoming more engaged in making healthcare decisions and managing their cost of care. The protection or promotion of the […]

Physicians always wish to get reimbursement in the first attempt. To get the reimbursement in the first attempt providers need to eliminate some repetitive errors. This can happen if the provider or their hired staff for billing can read EOB or ERA interpret correctly and understand. There is always some percentage of getting claims denied. […]

COVID-19 pandemic will have lasting financial loss effects on healthcare providers, but leveraging some of the capabilities developed to adjust and continuously provide service to patients during this pandemic can build more strong and smooth revenue cycle management for the healthcare industry. Telehealth is one of the biggest changes that came out of the pandemic […]