Revised Role of Prior Authorization So far insurance carriers have been using prior authorization as a tool to control spending and promote cost-effective care. But in changing billing scenarios role of prior authorizations has changed drastically. There is little information about how often prior authorization is used and for what treatments, how often authorization is […]
Providers continue to wonder how we can live in a world where so many RCM processes are handled quickly with technology, yet decisions that affect patient health are slowed by faxes and bureaucracy, even when there is only one clear treatment option. Yes, you are right, we are talking about Prior Authorization (PA) or Pre-Auth. […]
CMS recently proposed a rule to improve prior authorizations 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 […]
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 […]
Eligibility and benefits verification is the first and most significant step in the medical billing and coding process. Today’s continually changing and increasingly complex healthcare environment requires, more than ever, close attention to validating coverage, benefits, co-payments, and unpaid deductibles. With the eligibility and benefits verification process in place, you can collect more accurately. Thus, […]
The prior authorization process is seeking “approval from a health plan that may be required before you get a service or fill a prescription for the service or prescription to be covered by your plan”. Most often prior authorization (PA) and pre-authorization are used interchange However, most insurance companies will use the term “prior authorization” instead […]
CMS’s Proposed Rule on Automating Prior Authorization On 10th December 2020, The Centers for Medicare & Medicaid Services (CMS) proposed a new regulation aimed at improving the sharing of healthcare data between payers and providers and streamlining, a major administrative hassle for providers. This new rule will boost patient data exchange and streamline which will […]
Basics of Worker’s Compensation Worker’s compensation, commonly known as worker’s comp, is a type of insurance that covers the treatment of injuries occurring on the job. Employers typically purchase commercial worker’s comp policies directly, although some states administer these policies. Medical billers must therefore remain aware of the worker’s comp policies for their state, including […]
Providers seeing a 2 percent payment decrease on their Remittance Advice (RA) is due to a mandatory sequestration payment reduction. Claim adjustment reason code (CARC) 253 is used to report the sequestration reduction. The code will appear as a CO 253 on the RA ‘Sequestration-reduction in federal payment’ as the reason. For the Medicare Fee-for-Service […]
Insurance will deny the claim with denial code CO 29 – the time limit for filing has expired, whenever the claims submitted after the time frame. The time limit is calculated from the date service provided. Each insurance carrier has its own guidelines for filing claims in a timely fashion. Some are as short as […]