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Search Results for: Payer Contracting

Therapy Progress Notes
Stop Your Therapy Progress Notes from Triggering Payer Audits
Aug 7, 2024 - 1:00 ET
Expert Presenter: Beth Rontal LICSW

Insurance companies are cracking down on how you document therapy progress notes. Even simple mistakes can greatly reduce your ability to get paid, lead to payer audits, recoupments, and penalties.  This training can help.

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Get Higher-Paying Contracts with Proven Negotiation Strategies
Jul 23, 2024 - 1:00 ET

Don’t give up on your under reimbursing contracts due to lack of payer response to your negotiation requests. Learn how to improve payer contract negotiation results. Get the tools you need to secure higher rates and better terms.

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Overturn Rejected Claims: ERISA Appeal Letters to Get You Paid
Expert Presenter: Don Self CPC, CMCS, CASA

Combat non-Medicare and Non-Medicaid denials with proven ERISA appeal letter writing strategies. Online training helps you get more claims paid.

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Medicare audit
Medicare Audit Survival Tactics to Help Your Physician Practice
Expert Presenter: Osato Chitou Esq. MPH

The chances that your practice will face a Medicare audit are higher than ever. The latest stats show that payer audits quadrupled last year. Attend this training to make sure you’re ready when Medicare auditors knock on your door.

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No show
Cut Dental No Shows: Keep Your Schedule Full & Revenue Flowing
Expert Presenter: Kristie Kapp RDH

Last-minute cancellations and patient no-shows can destroy your dental practice’s profitability and upend your carefully planned daily schedule. Discover how to handle these issues

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Telehealth services for mental health
Stop Errors & Boost Pay for Telehealth Services for Mental Health
Expert Presenter: Dreama Sloan-Kelly MD, CCS, CPC

Auditors recently found that more than half of telehealth services for mental health are billed incorrectly. This online training will help you stop these common coding & billing errors to collect more for these complex claims.

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Credentialing: Master CAQH Portal Changes to Speed Up Pay
Expert Presenter: Yesenia Servin CPMSM, PESC

Accurately processing provider credentialing and enrollment requires the ability to swiftly navigate the CAQH portal, which recently changed. Discover how to save time and stress by getting a walkthrough from an expert.

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Denied Claims
Get Your Denied Claims Paid Fast with Proven Appeal Process
Expert Presenter: Tressa Harley

Get payers to overturn more of your denied claims so that you can receive more of the reimbursement you are due. Expert reveals proven appeal letter writing strategies and templates to quickly get more of your denied claims paid.

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Provider enrollment
Provider Enrollment 101: Critical Skills to Boost Accuracy & Approvals
Expert Presenter: Yesenia Servin CPMSM, PESC

Both commercial and government payers make provider enrollment more complex than it needs to be, but you’ve got an expert on your side. Get the proven tactics you need to providers approved faster and start getting paid sooner.

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Copays: What to Charge, When to Waive & How to Collect More
Expert Presenter: Amanda Waesch Esq.

Failing to collect copays and deductibles can get you into just as much trouble as collecting them incorrectly.  Protect your practice against costly violations with the actionable tactics in this healthcare attorney-led online training.

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managed care contracts
Managed Care Contracts: Proven Language to Get Paid More
Expert Presenter: Michael R. Lowe Esq.

Uncover language in your managed care contracts that can help your practice get paid more and avoid hidden pitfalls. Healthcare attorney Michael R. Lowe shows you how to make your managed care contracts work for you.

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Medical documentation
Protect Against Medical Records Documentation Errors, Audits and Fines
Expert Presenter: Amanda Waesch Esq.

Medical records are legal documents that support every aspect of patient care, and one medical documentation mistake can get you audited. Then violations, penalties, and unpaid claims follow. Protect yourself with this online training.

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ERISA Regulations
Stop Payers from Taking Back Your Claim Payments with ERISA

About 83% of your non-Medicare/Medicaid claims are governed by ERISA regulations. However, payers don’t want you to know how to apply these rules to take control of your reimbursement. This training shows you how.

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Balanced billing laws
Balanced Billing Laws: Prevent Avoidable Violations and Penalties
Expert Presenter: Rachel V. Rose JD, MBA

Avoid violating Balanced Billing Laws with step-by-step advice from expert Rachel V. Rose, JD, MBA. She’ll help you head off preventable out-of-network, financial hardship, and write-off errors that can cost you millions in penalties.

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Provider Enrollment and Credentialing
Credentialing/Enrollment 101, Get Approved/Paid Faster & Easier
Expert Presenter: Tracey Tokheim

Credentialing and enrollment 101 for physician practices. Step-by-step strategies to help you master credentialing and enrollment basics to avoid errors and ensure that your revenue keeps flowing.

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Provider credentialing
Master Provider Credentialing/Enrollment Online Site Requirements
Expert Presenter: Tracey Tokheim

Avoid common/costly errors and meet requirements of provider credentialing and enrollment online sites with practical advice from national expert, Tracey Tokheim. Improve your accuracy and results while reducing headaches.

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Onboarding a New Physician
Speed Up Credentialing & Reimbursement for New Providers

When onboarding a new physician into your practice, your process must be flawless. A simple mistake can result in sever reimbursement delays – or worse, payer rule violations.  With this online training you’ll get it right the first time.

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Physician credentialing
Head Off Provider Credentialing Headaches with Proven Tracking Tools

The physician credentialing process is a complicated collection of hoops to jump through and moving parts to track. Get a step-by-step, proven process to help you keep cash flowing.

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Managed care contracts
Expertly Negotiate Higher Rates from Payer Managed Care Contracts
Expert Presenter: Doral Jacobsen MBA, FACMPE

Get insurance carriers to reimburse you more. The key is in how you negotiate your managed care contract. Get expert insider negotiation strategies that give you a huge advantage during your contract negotiations.

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Boost ERISA Claim Payments with Simple Intake Process Changes
Expert Presenters: Radha Rathak Esq.; Dana Berkowitz Esq.

You can collect (and keep!) more money from your claims. During this training, two healthcare attorneys will walk you through how to fight back against reduced payer ERISA claim payments and get paid more of what you are due.

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Winning Claims Appeals
Persuade Payers to Pay Up with Successful Appeals Process
Expert Presenter: Kelly Grahovac MBA

CMS has plowed through their appeals backlog, opening their doors to reimbursing your claims FASTER. Get expert tips on winning appeals strategies that convince Medicare and private payers to give you the cash you deserve.

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Delegated Credentialing
Delegated Credentialing: Tactics to Speed Enrollment & Payments
Expert Presenter: Tammy West MHA/ED, CPMSM, CPCS

You can eliminate enrollment delays, get paid faster, and avoid re-enrollment disasters by getting your mid-sized to large practice set up to perform delegated credentialing. Get expert tactics on getting it right the first time.

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Modifier 59
Expert Tactics to Get Paid for Two Procedures on the Same Date
Expert Presenter: Dreama Sloan-Kelly MD, CCS, CPC

Modifier 59 is among the most frequently used modifiers, but also one of the most often denied. Halt those denials and bring in the pay your practice deserves with these essential modifier tips.

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Insurance demand letter
Fight Audits, Recoupments w/ Proven Demand Letter Responses
Expert Presenter: Sean M. Weiss CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC

When your practice gets an insurance demand letter, it’s no time to panic. Instead, create your response strategy with actionable tips from expert Sean Weiss during this essential online training event.

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NCCI Edits
Overturn Payer Denials Due to 2023 NCCI Edits & Get Paid More
Expert Presenter: Lynn Anderanin CPC, CPB, CPPM, CPMA, CPC-I, COSC

Bundling is a major source of denials, but you can fight back. This online training helps you overturn bad denials due to 2023 NCCI Edits and RVUs. Master the 2023 NCCI edits to reverse bad denials and improve your revenue.

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G3002 & G3003: Get Paid More w/New Chronic Pain Mgmt Codes
Expert Presenter: Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO

Get paid more for treating patients with chronic pain – learn to correctly apply new 2023 codes G3002 & G3003. Online training shows you how to code these services (G3002/G3003) more accurately & get higher reimbursement.

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prescription refills
Charge Patients Extra for Prescription Refills – Compliantly
Expert Presenter: Amanda Waesch Esq.

Before you start charging patients extra for the additional time it takes to refill prescriptions, you must have a handle on how to implement these fees correctly. You can compliantly get paid for prescription refills – find out how.

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Self-Pay Patients
Head Off Massive Financial Penalties for Innocent Self-Pay Billing Errors
Expert Presenters: Daphne Kackloudis Esq.; Ashley Watson Esq.

Correctly billing self-pay patients is more important now than ever. Self-pay patient numbers are rising due to the May 11 PHE expiration. This training will help comply with self-pay billing rules and keep you out of trouble with the Feds.

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Credentialing providers at multiple locations
Stop Payment Losses for Multi-Practice Credentialing Errors
Expert Presenter: Yesenia Servin CPMSM, PESC

Avoid delaying and losing reimbursements. Streamline your credentialing and enrollment process – more efficiently manage multiple providers and locations NPIs, Tax Ids, delegated agreements, and more. Proven online training.

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Denied Claims
Boost Your Medicare Appeal Results, Get More Claims Paid Fast
Expert Presenter: Sean M. Weiss CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC

Quickly get more of your denied claims paid with proven payer appeal strategies. The key is mastering the nuances of your appeals process by cutting through the red tape. Find out how…

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Incident to services
Get Paid 15% More, 2023 Split/Share & Incident-to Rule
Expert Presenter: Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO

Split/shared and incident-to billing rules have always been confusing, and they’re about to get even more vexing, due to new 2023 rules. Collect 15% more for your APP’s services by mastering the new rules during this training.

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Cash-only services
Get Paid More w/Patient Cash-Only Services & Comply w/Payer Rules
Expert Presenter: Amanda Waesch Esq.

You can stop providing administrative services to your patients for free. Many payers allow you to charge patients for these cash-only services if you do it compliantly. This expert-led online training will show you how.

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Third Party Payer
Negotiate Higher-Paying Third-Party Payer Contracts
Expert Presenter: Doral Jacobsen MBA, FACMPE

You can negotiate with third-party payers to increase your reimbursement – if you know how. This expert-leg online training will provide you with step-by-step contract negotiation strategies that word. Start getting paid more today.

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Intro to ADA CAQH ProView: Sail Through Dentist Credentialing Basics
Expert Presenter: Leslie Icenogle

Unfortunately, getting and keeping your dentists enrolled and credentialed in both commercial and government insurance plans is a necessary evil that can take hours, even with the ADA CAQH ProView online portal. The average dentist participates with 30 networks, and with each requiring credentialing every three years, that could mean you’re working on at least[...]

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Out of network billing laws
Comply w/Out-of-Network & Uninsured Patient Billing Rules
Expert Presenter: David Vaughn JD, CPC

Complying with recent changes when billing for out-of-network and uninsured patients is more complicated due to recent rule changes. Learn how to comply before the audits begin. Sign up for online training today.

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IDR Process
Get Paid for Out-of-Network Denied Services with New Federal IDR Process
Expert Presenters: Daphne Kackloudis Esq.; Ashley Watson Esq.

You can get paid for denied out-of-network services. The catch is that you must master CMS’ recently implemented IDR process. Get proven strategies to correctly utilize this new process to overturn these previously unpaid claims.

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PECOS: Practical Strategies to Cut Confusion & Improve Accuracy
Expert Presenter: Yesenia Servin CPMSM, PESC

Get the tactics you need to make utilizing the CMS PECOS online Medicare enrollment and credentialing system less confusing and more accurate. Attend this training for practical, expert advice so you get it right the first time.

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Non-covered services
Get Paid More for Commercial Payer Non-Covered Services
Expert Presenter: Dawn R. Cloud CPC, CMSCS, CHCI, CPDM

Billing patient directly may be your best bet of getting paid for commercial payer non-covered services, but you should NEVER do so without the correct forms on file. Attend online training to master non-covered services billing.

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Managed Care Contracts
Get Payers to Cut Burdens from Your Managed Care Contracts
Expert Presenter: Doral Jacobsen MBA, FACMPE

Payers include excessive administrative burdens in managed care contracts that delay your reimbursements and add hours of extra processing time for your staff. Get negotiation tactics to cut these burdens & save time and money.

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Outsource Medical Billing
Proven Tactics to Boost Your Outsourced Billing Reimbursement
Expert Presenter: Owen Dahl LFACHE, CHBC, LSSMBB

How you manage your outsourced medical billing vendor relationship can seriously increase your claims’ reimbursement and decrease your financial and legal risk. Expert Owen Dahl’s training will show you how.

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provider directory
Comply with New Provider Directory Validation Rules, Avoid Fines

Your practice is required to create and validate your provider directory listings or be faced with getting kicked off the panel. This online training will help comply with these No Surprises Act rules and keep your revenue flowing.

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medical billing 101
Billing 101 for Practice Managers: Tips to Boost Revenue and Reduce Headaches
Expert Presenter: Sherri Lewis CPB

There is a lot riding on the accuracy of the claims you submit. Missing even one step in the billing process can result in dire consequences — significant reductions in claim reimbursement, increased denials, overpayments/recoupments, refunds, and ultimately audits that lead to massive fines and penalties. From pre-authorizing procedures and collecting copays to appealing claims[...]

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Coding for non-coders
Coding for Practice Managers: What You Really Need to Know
Expert Presenter: Victoria M. Moll CPC, CPMA, CPRC

You depend on accurate medical coding to keep your practice’s reimbursement flowing — and though it’s not vital for everyone to know HOW to code, it is important to get a basic understanding of coding to preserve your income.

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Medical Record Audit
Stop Payer Auditors from Taking Back Your Reimbursement
Expert Presenter: Dreama Sloan-Kelly MD, CCS, CPC

Outpatient payer audits are skyrocketing in 2022. To survive you must be prepared. Get practical, real-word strategies to help you identify and resolve medical record hot zones in your practice – before you get audited.

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Virtual credit card
Increase Revenue by 5%, Stop Paying Virtual Credit Card Fees
Expert Presenter: Kem Tolliver BS, CMPE, CPC, CMOM

By making you use virtual credit cards for your reimbursement payments, payers are passing their processing fees on to you. You can refuse and keep more of the money your practice is due. This training will show you how.

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Cut Through Preauthorization Red Tape and Boost Your Pay up
Expert Presenter: Owen Dahl LFACHE, CHBC, LSSMBB

If you want to get paid, prior authorizations are a necessary evil. They put an intense burden on your practice, staff, patients, and you.  You can reduce the time they take and improve your overall approval rate with some expert help.

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Medicaid Audit
Reduce Medicaid Audit Triggers and Overpayment Demands
Expert Presenter: Knicole C. Emanuel JD

Attorney provides practical advice on how you can reduce Medicaid audit triggers at your practice, more effectively respond to Medicaid audit notices and documentation requests to significantly reduce overpayment demands.

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Physician Service Agreement
Physician Service Agreements: Reduce Risk & Get Paid More
Expert Presenter: Allison Pullins

Proven negotiation strategies to use before you sign your next physician/hospital service agreement. This expert training will help you get paid more and protect yourself and your practice against federal and state violations.

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Provider Enrollment and Credentialing
Faster & Easier Commercial Payer Enrollment & Credentialing
Expert Presenter: Merella Schandl MHA, CPMSM, CPCS

Commercial payers are taking their enrollment and credentialing deadlines more serious than ever. Missing a deadline by even a day can have serious consequences for your practice.  

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appeal letter template
Proven Appeals Template, Get Your Denied Claims Paid Fast
Expert Presenter: Leonta Williams RHIA, CCS, CCDS, CPC, CPCO, CRC, CEMC, CHONC

Get proven strategies to help you write an appeal letter template that will get more of your denied claims overturned and improve the reimbursement you receive.   Register for this expert-led online training today to find out how.

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Payer Contracting Negotiation and Reimbursement
3-Part Contracting Series: Make More Money from Your Payer Contracts
Expert Presenters: Doral Jacobsen MBA, FACMPE; Olga Khabinskay MBA

You don’t have to settle for the terms and payment amounts in your payer contracts. Implement these proven strategies to negotiate a better deal, keep the plans you what and know when it’s time to get out. Signup today.

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Out of Network Collections
Seriously Boost Payup with Proven Out-of-Network Collection Tactics
Expert Presenter: Owen Dahl LFACHE, CHBC, LSSMBB

Out-of-network collections are complicated. Successfully negotiating with payers, communicating with patients and getting paid what you are due is possible if you know how. Sign up for this expert-lead online training to find out how.

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2021 COVID-19 employment policy PTO laws
Get Your Patients Back After Being Dropped by Payor
Expert Presenter: Olga Khabinskay MBA

Master proven strategies to get payors to overturn your contract deactivation.  This expert-led online training will walk you through each step and help you head off lost patients by reactivating your contract.

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Terminating a payer contract
Stop Payer Contract Frustrations from Costing Your Practice Money
Expert Presenter: Doral Jacobsen MBA, FACMPE

Terminating a payer contract may feel like you’re slaying a dragon but do so for the wrong reasons and you could unintentionally slash your revenue too. Get the strategies you need to decide when you should walk or stay.

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Third-Party-Payer Appeals
Third-Party-Payer Appeals: Get Paid More of What You’re Due
Expert Presenter: John T. Synowicki JD

Get proven appeal strategies to help you overturn more third-party-payer denials and avoid claim reimbursement reductions. During this live online training, healthcare attorney tells you how.

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CMS 1500 Claim Form
Boost CMS 1500 Claim Form Reimbursement
Expert Presenter: Brenda Edwards CPC, CDEO, CPB, CPMA, CPC-I, CEMC, CRC, CPMS, CMRS, CMCS

Avoid common CMS 1500 Claim Form error that lead to delayed payments or completely rejected claims. Expert biller provides you with step-by-step advice that will get you paid faster and more accurately.

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Fill Your Schedule Fast with Proven Patient Recall Plan
Expert Presenters: Karen Hoffer LPN, AE-C ; Gail Scheller RN, AE-C

Without a recall strategy, many of your patients would never schedule their next visit. This lack of recurring patient care puts your practice at risk of losing hundreds of thousands of dollars in lost revenue…

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worriedwoman (1)
Improve Provider Payer Enrollment Approvals
Expert Presenter: Amy M. Niehaus MBA, CPMSM, CPCS

Getting and keeping your providers enrolled in the most popular payer networks is the only way to ensure the success of your practice. However, it can be complicated and time consuming, but it doesn’t have to be…

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Billing Strategies to Improve Your Claims’ Reimbursement
Expert Presenter: Stephanie Thomas CPC, CANPC

There is a lot riding on the accuracy of the claims you submit. Missing even one step in the billing process can result in dire consequences – significant reductions in reimbursement, increased denials, and ultimately…

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Protect Your Practice Against Audit Generated Penalties
Expert Presenter: Linda Duckworth CPC, CHC

As Medicare and private payers continue to go after reimbursement paid in error, the chances you’ll get audited has increased. Auditors can dig through your previously filed claims for a “look back period” of 6 YEARS…

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Get Closed Insurance Panels to Open Their Doors
Expert Presenter: Steve Selbst

Open the doors of those “closed” and “narrowed” insurance panels that will most benefit your practice. Don’t walk away from payers when they deny you access to the patients you want. Use these proven tactics to get…

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Medical insurance audit
4 Lessons You Can Learn From Medical Insurance Audits

It can be challenging to see a medical insurance audit as anything other than a headache. After all, auditors require reams of documentation, and there’s always a chance they’ll uncover a missing CPT code, an undated progress note, or another issue that requires you to pay back what you received from payers. However, you may[...]

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Insurance appeal letter
Master the Perfect Insurance Appeal Letter in 4 Easy Steps

When you get a denial from your payer, your first step may be to immediately start putting together an insurance appeal letter so you can capture the pay for services you’ve provided. That’s an excellent habit, as long as you know what to include in your letter. Check out four steps that can help you[...]

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99211 Documentation Checklist to Back Up Every Nurse Visit

Auditors routinely agree that when they review E/M notes, they tend to find that documentation for nurse visits (99211) is too brief. Even though these visits may actually be short and uncomplicated, your documentation must always demonstrate medical necessity for what was done. Consider these documentation guidelines for your nurse visits when you report 99211.[...]

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Insurance audit
8 Tips Help Build Your Practice’s Insurance Audit Response Plan

An insurance audit isn’t something you should ever take lightly. Therefore, it’s vital to respond appropriately if you do get news that an audit is hitting your practice. Consider these eight tips so you can respond compliantly if your practice gets an insurance audit letter. 1. Read the Insurance Audit Letter Carefully Some practices skim[...]

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Telehealth services
Check These Essential 2024 Telehealth Modifiers for Faster Pay

Medicare billing data indicates that most practices are still reporting a healthy number of services via telehealth. If you occasionally see denials for those visits, the problem may involve the modifiers you do and don’t use. Consider these three modifiers when you’re submitting telehealth claims to Medicare so you can collect accurate pay more quickly[...]

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Prior Authorization
Prior Authorization Errors Skyrocket: 3 Tips Help You Avoid Issues

Insurers are denying prior authorization requests at an alarming rate, and that means your patients can’t get the care they need — and you don’t get paid for your services. A new report indicates that inpatient prior authorization denials are up 26%, while prior authorizations and precertification's for outpatients rose 16% between 2021 and 2023.[...]

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medical customer service
5 Front Desk Cheat Sheets to Boost Medical Customer Service

Maintaining a high level of customer service isn’t a good habit just for retail, hotel and restaurant staffers. In fact, it’s almost more important to provide excellent medical customer service, because your staff members are dealing with patients at a vulnerable time — when they’re concerned about their health. There are hundreds of ways you[...]

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Insurance appeal
5 Common Insurance Appeal Errors (and How to Fix Them)

Medical insurance claim denials can be devastating to deal with. Not only do they take time and energy — they prevent your practice from collecting revenue for services you’ve already performed. The most common way to tackle a denial is to file an insurance appeal, which can help you reverse those denials. To ensure that[...]

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Managed care contracting
8 Managed Care Contracting Tips to Solidify the Terms You Need

Managed care contracting can strike fear in the hearts of even the most seasoned medical practice manager. One bad contract term can haunt you for years, particularly when it affects the income you’re bringing in. Your best bet is to do some legwork before you sit down at the negotiating table. Check these eight managed[...]

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Medicare demand
3 Ways You Might Respond to a Medicare Demand Letter

Whether you’ve coded a claim incorrectly, failed to justify medical necessity or made another error, you’re likely to receive a Medicare demand letter asking for money back in certain cases. Any time your MAC pays you $25 or more in excess of what they should have, you’re subject to the recovery and recoupment process, which[...]

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Telehealth billing
Avoid These 4 Telehealth Billing Errors to Keep Pay Flowing

Seeing patients virtually has become such a common practices that many healthcare providers and patients prefer it over in-person visits. The best way to keep your reimbursement flowing for these encounters is to ensure that your telehealth billing practices are compliant. Check out four common telehealth billing mistakes that could derail your pay for these[...]

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Prior authorization
5 Ways to Reduce the Prior Authorization Burden at Your Practice

Every practice knows that handling a prior authorization case load can be time-consuming and burdensome. Not only do payers require you to spend endless time filling out forms and even sitting on hold when you call, but they often end in erroneous denials. In fact, one OIG report found that an alarming 13% of Medicare[...]

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New G2211 Facts Help Guide Your E/M Reimbursement Strategy

Sometimes it may feel like you’re navigating the G2211 coding and payment rules without much guidance, since CMS updates about how to report this E/M add-on have been sparse. Fortunately, one Part B MAC has come out with nearly a dozen FAQs that untangle several issues that coders have encountered since this code became payable[...]

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Insurance ID card
The Anatomy of a Patient Insurance ID Card and What It Means

Your front desk staff members have an incredibly important job, and one critical responsibility is to get patient insurance ID card information when patients make an appointment, and then scan those cards when patients come in for their visits. Just as important as it is to gather information from a patient insurance ID card, it’s[...]

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Write off
3 Patient Charges You Can’t Write Off (and Some You Can)

Routinely writing off out-of-network or government program copayments or deductibles without meeting individual financial hardship exceptions will most certainly land your practice in hot water with the OIG and insurers. That is, unless you know exactly how to comply with the fraud, waste and abuse laws about which charges you can write off. Check these three charges[...]

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Don’t Look for G2211 Pay With Your E/Ms Until February

G2211 is one of the most eagerly-awaited codes of 2024, allowing your practice to collect an extra $16 from Medicare when you perform an E/M service for a patient whose ongoing care your doctor is providing. Practices that are counting on that extra pay to come through, however, should plan to wait just a bit[...]

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Transgender patient
4 Tips Help You Collect for Transgender Patient Services

Nearly 2 million Americans identify as transgender, meaning their gender identity is different from what they were assigned at birth. If your practice sees a transgender patient — even if the visit isn’t related to gender transition services — you may need to know which diagnosis codes apply to the visit, and that’s not always[...]

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Medical records request
How Many Records Can Auditors Request? You May Be Surprised

It happens almost every day: Practices already stretched thin with their existing responsibilities are asked to send hundreds of medical records to auditors for “review.” The additional work and stress from the medical records request pushes practices to their limits and seems excessive to most practice managers. What recourse do you have for these voluminous[...]

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RT and LT modifiers
Real-World Examples Guide When to Use RT and LT Modifiers

If you’ve ever coded a patient chart, you know about the LT (Left side) and RT (Right side) modifiers. Together, the RT and LT modifiers are used to show laterality — in other words, they describe which side of the body was addressed during a procedure or surgery, or if supplies are being prescribed. Check[...]

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Medicare coding errors
Check the Biggest Medicare Coding Errors of 2023: E/M & More

Every coder knows that although most providers perform evaluation and management (E/M) services nearly every day, coding these visits aren’t necessarily straightforward. That fact is backed up by data in the latest CMS report, which notes that established patient E/M codes 99211-99215 were riddled with errors, most of which were due to upcoding. The facts: CMS published[...]

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Radiology coding
3 Radiology Coding Best Practices to Keep Imaging Pay Flowing

Providers perform diagnostic radiology services not only to evaluate a patient’s condition, but also to follow up on progress or determine whether a treatment is working. Coding these services sometimes seems straightforward, but it’s easy — and dangerous — to get complacent about radiology coding. Check out three tips that can help you ensure that[...]

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Medicare claims
7.3% Medicare Error Rate Puts Documentation Issues in Spotlight

It can be unbelievably confusing to fill out your Medicare claims without making mistakes. But while errors are just a part of life in every other area, Medicare errors can be a different story. Auditors and reviewers are just waiting for you to put one wrong detail on your claims, allowing them to deny your[...]

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Contract negotiations
How to Respond When Payers Say ‘No’ in Contract Negotiations

Handling payer contract negotiations is never simple, and one area that many practices find particularly stressful is how to respond when a payer immediately says “no” to the terms you’re interested in pursuing. Although it can be off-putting to deal with an insurer who doesn’t want to work within your required terms, there are ways[...]

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OIG work plan
HHS Adds 3 Key Issues to Latest OIG Work Plan Document

Every practice knows that the Department of Health and Human Services (HHS) assigns its watchdog agency, the OIG, to review problematic issues at medical offices, and to investigate when warranted. Investigations may end up resulting in fines and penalties for practices, which is why it’s important to avoid these reviews if at all possible. One[...]

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ERISA documents
How to Gather ERISA Documents That Help You Slash Denials

The first step to filing ERISA appeals is to ensure you have all the ERISA documents you need from your patients — but that can be easier said than done. It can be challenging to get items like the summary plan description and coverage details. Check these methods that can help you gather the ERISA[...]

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CPT modifiers
3 Ways Payers Are Monitoring Your Use of CPT Modifiers

Without CPT modifiers, many coders would struggle to submit accurate claims to payers. Why? Because modifiers allow you to provide insurers with more information about a service or supply, without changing the meaning of the code they’re modifying. In many cases, modifiers can be the difference between a denial and a claim approval. Coders have[...]

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Medicare appeals
7 Tips for Medicare Appeals That May Help Reverse Denials

Unless you engage a consultant or attorney to assist, it costs nothing to submit Medicare appeals, but it can net you big money because you’ve already performed the service — and you deserve to get paid for it. Many practices avoid appealing denials because it’s time consuming, but if you know the ropes about Medicare[...]

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Patient payment estimator
Price Transparency: How to Give Accurate Estimates to Patients

If you’re looking for a new way to bring in cash, check out this statistic: About 52% of patients would pay $700 more by credit card when visiting a physician if they’d gotten an estimate at the point of care. That stat from a McKinsey quarterly survey of retail health care consumers demonstrates just how[...]

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Delegated credentialing
How Delegated Credentialing Can Help Practices Bring in Cash

Before your practice can get paid for your providers’ services, those clinicians must go through the payer enrollment process, which has multiple credentialing steps that can take upwards of six months to complete. And every day of delay when your providers aren’t credentialed means you’re losing money. The solution for many practices is delegated credentialing.[...]

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Patient billing
When Can You Charge Patients After Insurance Denials?

It’s a common occurrence at medical practices: You submit a claim to the insurer and in return, you get a denial. You don’t want to absorb the cost of the service you’ve already provided, so your next step is to determine whether you can bill the patient directly. While patient billing may be a complex[...]

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Insurance appeals
Master the Insurance Appeal Timeline to Fight Payer Denials

Working in healthcare is stressful enough without having to track your appeals on the calendar — but staying on time and meeting appeal deadlines will be essential if you want a strong chance of payers reversing their denial decisions. Your best bet in setting up your insurance appeals for success will be to make sure[...]

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Urine drug testing
3 Compliance Tips to Follow When Billing Urine Drug Testing

Because urine drug testing (UDT) codes don’t bring in massive reimbursement on a per-claim basis, many practices think the OIG isn’t paying much attention to these services — but that misconception can get you into trouble. In fact, the OIG frequently comes after practices that incorrectly report drug testing services, not only asking for refunds,[...]

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Reverse false claims
How Reverse False Claims May Land Your Practice in Hot Water

As most medical practices are aware, the government is the largest healthcare payer in the United States, and the country works hard to protect the funds that go out to pay for medical services and procedures. One way that goal is achieved is through the False Claims Act, a law that allows the government to[...]

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JZ modifier
Avoid Oct. 1 Denials: Report Modifiers JW and JZ Properly

When CMS debuted the JZ modifier last November, the agency gave practices until July 1 to start using it, allowing for a brief period so billers could get to know how the modifier worked. Unfortunately, some practices aren’t yet using modifier JZ, which could mean trouble starting in October—at which point Medicare payers will start[...]

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Telehealth toolkit
How to Use the OIG’s Telehealth Toolkit to Benefit Your Practice

If you’re curious about where you stand in terms of telehealth claim compliance, the OIG has a new tool that may help you sort things out. By using the government’s Telehealth Toolkit, you can evaluate how payers are reviewing telehealth claims and shore up any issues that may exist among your own. Check out a[...]

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Insurance contract
How to Leverage Your Strengths During Payer Negotiations

Once you’ve scheduled an insurance contract negotiation meeting with payers, you can’t simply breeze into the room without significant preparation. The best way to have the payer accept your terms is to identify any and all leverage you can use in the contracting process, and that’s easier said than done. It requires research and due[...]

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Medical collections
6 Steps to Collecting From Patients Before & During Registration

Medical practices leave a startling $125 billion uncollected every year due to poor collections practices. If you think your practice isn’t responsible for even a dollar of that number, you’re probably wrong. Even if you’ve instituted a medical collections overhaul at your practice, it’s likely that some money is being uncollected that you haven’t followed[...]

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Insurance contract
How to Time and Schedule Your Insurance Contract Negotiations

Handling health insurance contract negotiations can give any practice manager a headache. There’s so much to remember, including which terms to avoid, who your contact should be at the payer organization, which rates work best, and much more. Among the issues that many practices struggle with is how often to renegotiate with payer sources. Read[...]

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Modifier 25
Cigna Delays Plan Requiring Medical Records With Modifier 25

UPDATE: Cigna has delayed the requirement described below, and it will no longer take effect on May 25. The company has not yet indicated when it will go into place, so keep an eye on the Healthcare Training Leader website for more information as this story develops. When you perform a minor procedure along with[...]

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Prior authorization
How Medicare Advantage Prior Authorization Will Change in 2024

If your practice is like most, you’ve faced myriad headaches dealing with Medicare Advantage (MA) denials. In some cases, even when MA plans approve prior authorizations for certain services, you end up facing denied claims. Thanks to a new rule, however, that issue should go away in January. Background: On April 5, CMS issued a[...]

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Which Telehealth Rules Will Go Away When the PHE Ends?

Ever since the public health emergency (PHE) began during the early days of the COVID-19 pandemic, practices have gotten accustomed to the adjusted rules and regulations, which have included more telehealth flexibilities than ever before. However, when the PHE ends on May 11, many of those provisions will go away. Find out which telehealth PHE[...]

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Administrative fee
5 Administrative Fees Your Practice Could Charge to Earn More

Perhaps your practice has had success charging for no-shows or sports physical form completions—or maybe you’re just starting to investigate which administrative fees you might explore. Either way, there are many factors to consider if you’re thinking of charging administrative fees, but before you dot your I’s and cross your T’s, you might want to[...]

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Split/shared billing rules
Master 2023 Split/Shared Billing Rules With Key Tips & Examples

When a split/shared visit takes place, both the physician and the nonphysician provider (NPP) perform part of an E/M visit in the facility setting. The tricky part comes in when determining which provider should actually report the claim for the service. Check out a few tips so you can ensure your practice is following the[...]

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Recovery audit contractors
Prepare for Your RAC Audit With 7 Time-Tested Tips

When a recovery audit contractor (RAC) decides to audit your practice, you must cooperate, or you can be excluded from Medicare or cut off from reimbursement. It’s also important not to panic. As long as you have a RAC preparation strategy, your audit should go smoothly. Get ready for recovery audit contractors with these seven[...]

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Mental health records
10 Factors That May Trigger Mental Health Pay Recoupments

When an auditor reviews your mental health records, they’re looking for specific elements that will justify the money they paid you for your services. And if they can’t check off every box, they won’t hesitate to recoup your reimbursement. To anticipate exactly what auditors are looking for in your mental health records, check these 10[...]

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Medicaid audit
OIG Outlines the Biggest Medicaid Audit Findings of 2022

If you were curious about whether the OIG had stepped up Medicaid audits as the pandemic’s effects began to wane, it’s time to stop wondering. The agency finalized 1,327 convictions last year, recovering $1.1 billion during 2022. And even though many practices equate audits solely with Medicare, the latest OIG report confirms the fact that[...]

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Insurance contract
How to Navigate Negotiations and Land a Great Payer Contract

It can be tempting to put off your managed care contract negotiation responsibilities because working with payers feels like a self-defeating task. After all, insurers are poised to say “no” to every negotiation technique you attempt, and you certainly don’t want to accept the first terms they offer. There are, however, ways to navigate those[...]

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Concierge medicine
5 Considerations Before Shifting to a Concierge-Based Practice

As every medical practice staffer is aware, dealing with insurance companies, chasing down copays and processing denials can cause hours of wasted time. This has led some providers to consider transitioning their practices to a concierge model, where patients pay a fee (typically either annually or monthly) for membership. Although there are some options allowing[...]

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5 Staff Training Tips to Help Sidestep QMB Billing Issues

Medical practices may see Medicare and Medicaid patients every day. What could be less common at your practice, however, is a patient who has both Medicaid and Medicare, known as a qualified Medicare beneficiary (QMB). All Medicare providers—not just those that accept Medicaid—are prohibited from charging QMB patients for cost-sharing. If you’re in this category[...]

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Medical front desk
5 Regulatory Issues Every Front Desk Staff Member Must Master

Being at the front desk of a medical practice can sometimes feel like you’re running interference at an air traffic control station. From working with insurers to calming frustrated patients, the job can be all-encompassing. One area that some medical front desk staffers may not have time to focus on is unfortunately one of the[...]

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Prompt pay discount
When Prompt Pay Discounts Are OK (and When They’re Not)

As patients grow increasingly savvy about researching healthcare prices, they’re more likely to ask practices for discounts that apply to anything from office visits and radiology services to surgeries and dental procedures. As many practices are aware, not all discounts are created equal—some are legal, while others are not. Fortunately, prompt pay discounts are allowable[...]

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E/M codes
CMS: E/M Codes Linked to Over $1 Billion in Improper Payments

Every coder knows that although most providers perform evaluation and management (E/M) services nearly every day, coding these visits aren’t necessarily straightforward. That fact is backed up by data in the latest CMS report, which notes that E/M codes 99202-99215 were responsible for more than $1 billion in improper payments during the most recent 12-month[...]

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Provider enrollment and credentialing
3 Provider Enrollment Barriers and How to Overcome Them

One of the simplest and fastest ways to keep reimbursement flowing at your practice is to ensure your provider enrollment and credentialing processes never face any hiccups. After all, if you don’t get your providers enrolled and credentialed swiftly, they could be terminated from payer networks and dropped from hospital admitting rolls. Plus, you’ll be[...]

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Evaluation and management codes
See How Coding for 2 E/M Visits on 1 Day Dramatically Changed

It’s a question that has confounded coders and practice managers for years: What do you do if you see a patient in your office, then admit them to the hospital because the condition requires more acute attention? Reporting two evaluation and management codes representing the different sites of service has not been an option in[...]

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Amending medical records
5 Tips to Remember for Compliant Documentation Amendments

Contrary to popular belief, you can sometimes make amendments to medical documentation after the date of service, as long as you know the rules. The key is to ensure you’re following payer regulations, state laws and internal compliance guidelines that your practice has in place. As long as you check those boxes, amending the medical[...]

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recovery audit contractors
Avoid Paybacks to RAC Auditors by Following 7 Essential Tips

One audit type that’s always looming over medical practices involves Recovery Audit Contractors (RACs). These organizations are appointed by each MAC to uncover, confirm, and take back reimbursements Medicare made in error. Because they get paid a percentage of what they recover from medical practices, RACs are sometimes referred to as Medicare’s “bounty hunters.” Recovery[...]

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How Practices Can Avoid the Most Common Incident-to Red Flags

When an advanced practice provider (APP) sees patients at your practice, your payer will reimburse you at 85 percent of the fee schedule amount—unless you bill using the incident-to rules, which can net you the whole fee schedule amount. To submit your claims under incident-to, you must ensure that the physician created the initial plan[...]

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ABN form
How to Collect for Non-Covered Services Under MA Plans

Most practices know the ropes of using an Advance Beneficiary Notice (ABN) of Non-Coverage: When a service might be denied and you want Medicare patients to understand what their financial responsibility may be, you have them sign the ABN. But what happens when you see a patient who has Medicare Advantage rather than a Part[...]

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Managed care contracts
Decipher Confusing Payer Contract Language & Get Paid More

If you’re among the medical practice staffers who groan when it’s time to review managed care contracts, that could be because you know payers bury confusing language into the documents. One step to understanding what these contracts say is to break down each section and look for key phrases that can help you reduce confusion[...]

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CPT code 99211
Check These Four Documentation Rules for Reporting 99211

Your nurses are vital to your office’s operations, and the income they generate is vital as well. But if you don’t ensure that they document their visits properly, you could be throwing thousands of dollars out the window. That’s because payers and government auditors are reviewing documentation for nurse-visit CPT code 99211, and if they[...]

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outsourced medical billing
Evaluate Your Medical Billing Firm by Tracking These KPIs

Many practices find that outsourcing the billing function can help improve workflow at the medical practice, reduce errors, process claims faster and boost profitability. But if your billing partner isn’t providing you with reports, you may not be able to measure the most important key performance indicators (KPIs) that help you evaluate whether the relationship[...]

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provider credentialing
5 Steps Help You Reach Payers, Speed Credentialing Processes

Getting payers to respond to your provider credentialing and enrollment questions sometimes feels impossible, but without their help, you won’t be able to process your applications, which means you can’t bill for new providers. There are, however, concrete ways you can reach insurers and get responses to your credentialing questions. Check out five expert-tested ways[...]

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risk adjustment
Risk Adjustment: Are You Self-Auditing ICD-10-CM Codes?

Medical practices can get paid more for Medical Advantage claims by accurately reporting patient risk—but the main way insurers evaluate risk is through your diagnosis codes. And if your practice isn’t performing ICD-10-CM self-audits, you could be underrepresenting your risk and shorting your practice significant income without even knowing it. Background: Risk adjustment is a[...]

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revenue cycle
Build the Ideal Revenue Cycle Team With This Quick Primer

The best way to ensure that you bring maximum revenue into your practice is to involve several key team members in the revenue cycle process so you can master every step along the way. And once you identify the participants, you’ll need to train them properly to keep the entire team running at maximum potential.[...]

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Healthcare audit
Key Strategies Help You Avoid a Medicaid Audit

As part of the Centers for Medicare & Medicaid Services (CMS), Medicaid auditors are eager to come after potential instances of fraud or abuse that could cost you a fortune in fines, penalties and exclusions if you aren’t careful. Check out several areas that Medicaid auditors are targeting, and find out how you can stay[...]

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Advance beneficiary notice
Keep These ABN Formatting Tips in Mind to Stay Compliant

To keep reimbursement flowing into your practice, you must understand how to complete an Advance Beneficiary Notice (ABN) of Non-Coverage. But having a high success rate with your ABNs goes beyond filling out the fields correctly. You must also use the right paper size, font, and ink color, or you may end up having to[...]

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provider directory
Cut Your Risk: Update Provider Directory When Providers Leave

Every practice manager knows the importance of creating policies and processes to follow when a new provider joins — but it’s important to remember that you must also create know what to do when a provider leaves your practice. And even if you have a list you’ve been using for years, there’s one item that’s[...]

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denied claim appeal letter
Include These 5 Items in Your Appeal Letter to Achieve Success

Every medical practice has been there: You get a notification from an insurer that your claim is being denied, downcoded, or held for more information. In many cases, this can mean thousands in lost reimbursement for a service you’ve already provided. Therefore, your best bet is to appeal inappropriate denials so you can recoup the[...]

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No show policy
3 Items Your No Show Policy Must Include—And 2 to Leave out

If you’re among the practices that still don’t have a no show policy in place yet, you’re probably losing thousands every year. No-shows have an estimated $150 billion annual industry impact, and the average practice loses $200 per every unused time slot. This means if one patient misses an appointment every day, you lose $52,000[...]

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managed care contracts
Avoid Payer Contract Horrors: Know When to Call Your Attorney

Whether you’re negotiating managed care contracts for the first time in your career or you’re a seasoned pro, one thing is certain: you can’t afford to make a mistake. Reimbursement from managed care insurers is likely to make up the bulk of your practice’s income, so it’s critical that you understand exactly what language to[...]

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medical coding
Improve Coding Accuracy, Claim Pay-up w/Entire Practice Team

As a practice manager, you are responsible for making sure that everything in your medical office runs smoothly, and that includes getting paid. The only way to do this is for you to have at least a basic understanding of how medical coding works, why payers hold it in such importance, and why it’s so[...]

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99211 Q&A: Get Paid More for Your Nonphysician Staff Services

You can get paid for the additional services provided by your medical assistants and registered nurses provide. The amount depends on the number of non-physician staff you employ. For a small practice, this can equal as much as $20K more per year. To access this additional reimbursement, you must correctly utilize CPT code 99211 for[...]

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CAQH ProView
CAQH: Comply w/Provider 90-Day Revalidation No Surprises Rule

The No Surprises Act has now made it mandatory to revalidate all provider information every 90 days – for every single payor your practice contracts with. Missing even one revalidation period could mean you risk losing your contract with a payor, without warning. To make this time-consuming task easier and less time intensive, you should[...]

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Appeal letter
Avoid These 6 Payor Appeal Letter Mistakes & Get Patients Back

Getting dropped by any of your payors is a nightmare, especially if it causes you to lose patients because you’re now out-of-network with their insurance. The first step toward getting reinstated with any payor is to write an appeal letter asking for reconsideration. But this letter must be carefully crafted in order to help you[...]

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Medicare excluded individuals
OIG Exclusion List: Avoid Losing Your Medicare Billing Rights

As a practice that accepts Medicare and Medicaid, you are required to know the exemption status of your candidates, employees, and vendors. Failure to do so can have dire consequences, such as significant fines, loss of your ability to bill Medicare and Medicaid, and even jail time (in extreme cases). Even an innocent mistake can[...]

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No Surprise Act: Avoid Billing Violations for Out-of-Network Plans

Legally, you are not required to bill a patient’s secondary insurance plan if you are out of network. Instead, you can choose to bill the patient directly, but doing so can put you at odds with the No Surprises Act implemented Jan. 1st of this year. This new regulation requires that you follow very clear[...]

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Modifier 58
Modifier 58 vs 78: Boost Pay-up for Post-Op Procedures

Using modifier 58 to code post-operative procedures can prevent payer denials and decreased reimbursement for services – but you must use it correctly. When coding post-op procedures, most problems occur because of the similarities between two key modifiers: Modifier 58 - staged or related procedure or service by the same physician during the postoperative period,[...]

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Payer contract negotiations
Administrative Burden: Ace Payer Negotiations, Get More Money

Payer contract negotiations get more frustrating every year. There’s the piles of paperwork, the back-and-forth, and the ultimate worry that one wrong move is going to cost your practice money. When you begin the negotiation process, it’s important to bring everything possible to the table to increase your chances that your final contract will be[...]

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Medicare Revalidation
Medicare PECOS Enrollment Revalidations Resume Oct. 2021

On October 3rd, CMS announced that it is resuming Medicare revalidations of provider enrollment information in the PECOS system in October 2021. If you are an existing Medicare provider and missed your revalidation due date because of the Public Health Emergency (PHE) deferral, CMS will be implementing these in phases. Effective October 31st, Medicare Administrative Contractors (MACs) and National Supplier[...]

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No-Show Policy
Write a No-Show Policy That Gets Patients to Comply

Patients not turning up for their scheduled appointments is certainly not a new problem, but that doesn’t mean that you have to sit back and accept a high no-show rate as a normal part of running your practice. No-Show Policy. If your no-show rate is anywhere near the national average of 27%, you are losing[...]

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Doctor patient relationship
When and How to Terminate a Physician-Patient Relationship

Q: We have a challenging patient with a chronic illness that is never satisfied and continues to threaten to sue our practice related to even the simplest mistake. Obviously, this is not a good fit. Can we discharge this patient and terminate our doctor-patient relationship with them? Doctor patient relationship. ~ North Carolina Rheumatology Practice Manager[...]

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No-Show Fees
Set Patient No-Show Fees That Comply with Payer Contracts

Although it's common to charge patients a no-show fee to deter missed appointments, there is more to it than just modifying your office policies. No-Show Fees. If implemented incorrectly, charging a no-show fee can increase your risk of violating payer contracting rules, and result in higher losses than the original missed appointments. It’s vital that[...]

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physician patient relationship
End Doctor Patient Relationship Carefully to Stop Costly Lawsuit

While dismissing a problematic patient from your practice is never pleasant, things can turn downright litigious if you fail to exercise caution. If you don't want to get sued, here are several key items you must consider before terminating a physician patient relationship at your practice. Timing is Everything  Although there are several crucial steps[...]

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Medicaid audit
Prevent Medicaid Audit Triggers, Fast and Easy

Providing care to Medicaid patients, although much needed, certainly isn’t easy. There are numerous complex rules you are required to follow as a Medicaid provider. It’s up to you to stay up on these rules and policies to avoid potential pre- and post-payment Medicaid audits, reviews, and referrals. Or for more serious matters, dealings with[...]

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responses to your voicemails
Proven Tactics to Get Your Voicemails Answered More Quickly

Have you noticed that people rarely answer their phone anymore. They screen their calls, and decide later whether to call you back or not. Then, when they do call you back, they are likely to get your voicemail, and the telephone tag cycle begins. responses to your voicemails. Getting responses to your voicemails more quickly[...]

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Patient Abandonment Lawsuit
Stop Costly Reasonable Notice Errors When Ending a Patient Relationship

Reasonable notice is a component of the process to correctly terminate your relationship with a patient.  The goal is to provide your patient with enough time so that they can comfortably find a suitable replacement to take over their medical treatment.  If the patient feels rushed or like you’ve turned your back on them, the[...]

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Medicare Participating Provider
Medicare PAR vs Non-PAR: Reduce Hassle and Boost Cashflow

Choosing the wrong Medicare participation status for your provider can have significant financial consequences for your practice. Your choices are a Medicare Participating Provider (PAR) or a Medicare Non-Participating Provider (non-PAR). If you make the wrong choice, your allowable reimbursement can be limited, or you can end up unable to get paid by Medicare at[...]

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Use PECOS to Speed Up Medicare Enrollment Efficiency

Whether you’re enrolling your provider with Medicare for the first time or responding to a revalidation request, knowing how to correctly utilize CMS’ Provider Enrollment, Chain, and Ownership System or PECOS Medicare enrollment system is essential. What is the PECOS Medicare Enrollment system, anyway? PECOS is an internet-based enrollment process that provides you with an[...]

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RAC Audit
RAC Audit Response and Appeal Survival Tactics

Although last year’s pandemic put a brief pause on Recovery Audit Contractor (RAC) audits — this year they are once again in full swing. Auditors are picking up the pace to make up for lost time. So, your chances of getting audited are higher than ever before. What is a RAC Audit? RAC audits are[...]

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CAQH ProView Portal
CAQH ProView Portal: Make Credentialing/Enrollment Faster & Easier

Your patients pay for their health insurance and want to use it. This means that if you want to treat them, you need to be enrolled in their health insurance plan. Participating in insurance networks almost certainly guarantees you will be required to utilize the Council for Affordable Quality Healthcare (CAQH) ProView Portal, and it[...]

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Practice's Worth
Prove Your Practice’s Worth to Payor and Reap the Financial Reward

Payors may not come right out and ask you to prove your practice’s worth but being able to do so can have a significant impact on your bottom line. practice's worth. Proving your worth to a payor can get you reactivated after you’ve been excluded from a plan or get you in the door after[...]

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Billing modifier 62
Step-by-Step Tips to Head Off Modifier 62 Overpayments

The January 2021 updated OIG Work Plan makes it clear that the Office of the Inspector General (OIG) is paying attention to surgical modifier 62. The Work Plan states.billing modifier 62. “…we plan to audit a sample of claim line items specifically where different physicians billed for the same co-surgery procedure code, for the same[...]

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Contract Negotiating Strategies
Boost Your Payments by 10% with Expert Contract Negotiating Strategies

It can be frustrating dealing with payers when you don’t have a track record of success, but you don’t have to accept the payer’s terms as they present them. You CAN get favorable rates. Knowing the right questions to ask and having a strategy to negotiate can lead to a healthier bottom line that your[...]

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COVID Vaccine Admininstration Coding
Get the Correct COVID-19 Vaccine Administration Code and Pay

You MUST use a totally different system to get paid and code for COVID-19 vaccine administration; unlike other vaccines that use generic administration CPT codes, coronavirus vaccine reporting requires unique codes. Get up to speed now on the available vaccines and how to report them correctly from your very first claim without over billing. There[...]

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holiday party ideas during COVID
Plan Your Holiday Office Party with COVID-19 in Mind

It’s hard to believe less than a year ago your practice was decking the halls, getting ready for your end-of-year holiday party. Little did you know that 2020 would bring an end to crowded banquet hall celebrations packed with people without face coverings. The good news is you CAN still celebrate the holidays and your[...]

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Medical records copying fees
Avoid Copying Fees Violation, Pinpoint the Right Medical Records Rule

QUESTION: When a state has a cap on the allowed records copying rate, is there ever a situation that justifies exceeding the maximum allowance? Sometimes, the request for the records is for a long-term patient, so there are a lot of pages to copy. Would this case permit charging more than the allowed max charge[...]

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5 FAQS Snag More CARES Act Provider Relief Money

The government is throwing you another bone to dig out from all of your pandemic losses and operating expenses. The Department of Health and Human Services (HHS) announced an additional $20 billion for provider relief phase 3 funding. But with a short deadline, your chance for securing additional or first-time money is running out! HHS[...]

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Renegotiating Payer Contracts
6 Winning Contract Renegotiation Tactics

You can increase how much your third-party contracts pay. But it’s not easy. Insurers won’t help you to the money that’s just waiting on the table. And you may lack the confidence and experience to overcome their sneaky contract reimbursement reduction strategies. To renegotiate a payer contract that protects your practice’s profits, follow these tips:[...]

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2021 EM Coding Changes
CMS Rule: Prepare for Huge 2021 E/M Code Changes

You’ve been anticipating the CPT 2021 E/M coding changes and holding your breath on whether your payers will follow suit. Now with the 2021 proposed Medicare Physician Fee Schedule you can count on at least your MAC to align its coding and payment rules with AMA’s rehauled guidelines. The updates will shake up your E/M[...]

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Medicare ABN Mandatory
Is an ABN Mandatory or Voluntary? Here are 4 Clues to Decide

The Medicare Advance Beneficiary Notice (ABN) form is only one page long, but accurately completing the process can be as tedious as waiting for the repair man to show up. And it’s really critical that you take the time to get each step right, or you’ll be faced with increased write-offs and could even land[...]

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OIG Telehealth Audit
Learn How to Avoid Telehealth Audit Traps

It’s now official: your telehealth services are on CMS’ radar. The Office of Inspector General (OIG) just announced that it will start reviewing claims for specific violations. The last thing you want to do is pay back money for incorrect telehealth reporting. But that’s exactly what could happen if you don’t tighten up your telehealth[...]

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Terminate patient
Terminate a Patient Without Getting Sued

While it may seem a little unfair, patients can switch providers—no questions asked—with nothing more than a call to your practice asking to have records transferred. Unfortunately, when you’re the one making the split, terminating a patient-physician relationship isn’t so cut and dry—think abandonment lawsuit and medical malpractice. Before You Terminate a Patient... There are[...]

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Head Off $2 Million Medical Billing Fraud and Abuse Violation

You could be fined up to $11,000 for each false item or service you submit to Medicare. That means, your total penalty amount could be HUGE – reaching into the millions as it did for one physician practice. Halt massive penalties from crippling your practice by fixing these common medical billing fraud and abuse errors.[...]

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Employee Positive COVID OSHA
Employee With COVID-19: Prevent OSHA Violation

Question: We are testing employees daily for COVID-19 to protect staff and patients. If an employee tests positive for COVID-19, are we required to record an OSHA incident? Question from Los Angeles, CA subscriber Answer: Occupational Safety and Health Administration (OSHA) requirements mandate that you record certain work-related illnesses. COVID-19 is included in the regulation[...]

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Medicare AWV COVID
Rebuild Wellness Visit Revenue During COVID-19

Providing routine patient care under COVID-19 restrictions has been a delicate balance. While following physical distancing and infection control safeguards, you also have to protect your bottom line. These three strategies will help your practice more successfully offer Medicare annual wellness visits (AWV) and preventive services in new ways to restore your finances and provide[...]

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PECOS Surrogacy
PECOS: Simple Solution Expedites Enrollment Process

QUESTION: I have been using my providers’ PECOS (Provider Enrollment, Chain and Ownership System) passwords and logins to update their Medicare and Medicaid enrollments. When I submit their information, the required signature at the end indicates that I am the practitioner, when I’m clearly not. Should we consider handling updating enrollments a different way? Question[...]

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Cost Sharing Waivers
Avoid COVID-19 Fraud: Comply with Cost Sharing Waivers

CMS and private payers have recently implemented a variety of prior-authorization, copay and cost-sharing billing waivers for the COVID-19-related services you supply to your patients. Many of the services included in these waivers are being made available to patients at no cost. This helps prevent the inability to pay for services as a barrier to[...]

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5 Steps Prevent Overcharging COVID-19 Testing

If your practice is testing patients for COVID-19, you’ve got a bunch of new codes and payment rules that you need to follow, so you get paid on time, every time – without violating kit reimbursement law. In the past few weeks, CMS has released a significant amount of guidance on COVID-19 coding and co-pay[...]

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New CMS Telehealth Rule: Speed Cashflow, Update Billing

Just when you thought you got your head semi-wrapped around Medicare telemedicine rules, they go and throw it out the window! On March 30, CMS issued an Interim Final Rule and released new guidance on how to code and bill for rapidly evolving telehealth services. Before you file another claim, here are the three sweeping[...]

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Cheat Sheet Masters Emergency Telemedicine Policies Coverage

Your head is spinning as you try to recommend remote service solutions to your providers. To make an intelligent presentation to your doctors, you need to do some homework, so you’re getting the coverage you expect and avoiding hot-water regulations. Get a jump start with expert practice management and reimbursement tips from nationally-recognized coding and[...]

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Prevent HIPAA Penalties: 5 Emergency Disclosure Rules to Follow Now

As COVID-19 quickly spreads across the country, so will the requests for access to patient Protected Health Information (PHI).  These requests can come from a variety of sources (i.e. patients, health departments, government agencies, family members, guardians, etc.).  It is imperative that you have a firm handle on your obligations and your patients’ rights when[...]

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psychotherapy CPT
2 Proven Strategies Boost Psychotherapy CPT Code Pay

Stop leaving dollars on the table for mental health services for intake and time. You can add hundreds in revenue using psychotherapy CPT coding tips. Implement these expert tactics to up your reimbursement without attracting unwanted audit attention. Bill New Intake Session after Patient Absence (Codes 90701, 90792) Because many plans pay more for CPT®[...]

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Avoid Audits, Write-Offs With Mandatory or Voluntary ABN Form

QUESTION: What do educators mean by mandatory vs voluntary ABN? Is it the same form? Question from Long Island, NY Subscriber   ANSWER: To secure payments and prevent audits, you must have your patients sign a Medicare Advance Beneficiary Notice of Noncoverage (ABN) form. Don't risk fines and face write-offs by not issuing the form[...]

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Boost Your Online Reputation to Drive Referrals and Bring New Patients

Like it or not, your online reputation impacts your ability to attract new patients. Positive patient reviews boost your practice’s credibility and drive referrals. Remember — you never get a second chance to make a first impression! When it comes to your online reputation this is especially true. A recent Software Advice survey reports that[...]

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Billing Waivers
5 Steps Make Financial Waivers a Good, Not Risky Deed

QUESTION: We serve a large volume of underprivileged patients who can barely afford to eat. Our doctors often want to help them by waiving their deductibles and co-pays. Could we get in trouble for doing this “good deed”? Cookeville, TN Subscriber ANSWER: Waiving a patient’s co-pay, deductible, or co-insurance can put your practice at risk[...]

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Balance mistakes
Don’t Let Everyday Billing Mistakes Land You in Legal Hot Water

Billing mistakes have more serious implications than you just seeing a decrease in your reimbursement.  Some of the most common billing errors can get your practice audited, and result in you paying massive violation penalties. Unfortunately, accurately billing for outpatient services is so much more complicated than just submitting a claim or sending an invoice.[...]

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Payer Negotiations: 5 Fee Schedule Prep Steps to Lock in Higher Rates

Preparation is key to any project or endeavor, and payer contract negotiations are no different. If you don’t have your ducks in a row including your fee schedule pricing demands and arguments, you could be shut down before you’re even out of the gate. The fee schedule portion of your payer contract outlines the rate[...]

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Prior Authorization Billing
8 Tips to Speed Up Your Prior Authorizations and Reimbursement

Most patients are waiting for prior authorizations and that wait is negatively impacting their care. That’s why it’s critical that you get patient prior authorizations approved as quickly as possible — so you can get paid and your patients can get the treatment they need. The good news is that you can reduce your prior[...]

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Medicare ABN
4 Medicare ABN Steps to Promote Payment, Prevent Penalties

To secure payments and prevent audits, you must have your patients sign the correct version of the Medicare ABN form. Don’t risk fines and face write-offs by submitting the wrong form — educate yourself on when a Medicare ABN is mandatory or voluntary to protect your practice against unpaid claims. What is a Medicare ABN?[...]

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Primary Care First Model
Can Primary Care First Model Boost Your Pay?

If you are a primary care provider who treats Medicare patients — and looking to increase your revenue — the Primary Care First model might be just what you’re looking for. Earlier this year, CMS announced its Primary Cares Initiative, consisting of two new Alternative Payment Models (APMs). Both qualify as Advanced APMs for participation[...]

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third-party payer appeals
6 Tips for Successful Third-Party Payer Appeals

When even the slightest mistake on a claim form can lead to a denial or reduced reimbursement, you need to be on your toes. The good news is with some leg work third-party payer appeals can get you paid more of what you are due. While third-party payer appeals are a time-consuming complex process, they’re[...]

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OIG Watch List: Protect Payments from Urine Drug Test Audits

The Office of Inspector General (OIG) added to its Workplan items that contractors will audit or evaluate with a more critical eye. If you bill for urine drug test or speech-language pathology services to Medicare beneficiaries, now’s the time to weigh your compliance risk and fix any issues. OIG Scrutinizes Urine Drug Test, Speech-Language Pathology[...]

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6 Easy Steps to Unlock Your Well Woman Exams Pay Up

Getting reimbursed for preventive well woman exam claims is tricky - not all third-party payers reimburse for these services and the coverage rules vary for the payers that do. You can't afford to mess up the ABN or the allowed codes. Remove barriers to get the reimbursement you deserve by following a handy step-by-step guide.[...]

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Modifier 59: Anthem BCBS Rolls Out More Prepayment Audits – 25, 57, RT/LT Affected Too

Expect payment processing delays for claims with modifier 59, 25, 57, RT/LT from Anthem BlueCross BlueShield plans. The carrier has now implemented clinical prepayment reviews  in 14 states. October 1 saw the program roll out in 10 new states including New York, Georgia, and Ohio. You may have several questions on why the insurer has[...]

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Patient Dismissal Letter
3 Steps for Firing a Patient Without Incurring a Lawsuit

A patient can terminate the physician-patient relationship at any time and is always free to seek another provider. The physician, however, cannot fire a patient, without risking a patient abandonment complaint. When the time comes to terminate the relationship, take these actions to terminate patients in a smooth legally-free manner. Provide a Patient Dismissal Letter[...]

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Ask an Expert: What CPT Code Applies for a Blood Pressure Check by a Nurse?

QUESTION:  Can you bill CPT Code 99211 for a blood pressure check by the nurse? The patient did not see the doctor. - Anonymous, Salt Lake City, UT ANSWER: You may bill CPT code 99211 for a blood pressure evaluation for an established patient whose physician requested a follow-up visit to check blood pressure. CPT[...]

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Your Top Frustrations Are Staffing, Compliance Changes – Practice Management Survey

If staffing concerns keep you up at night, you’re not alone. Finding/keeping staff and keeping up with compliance changes are the top practice management and compliance issues that practice managers and physicians face, according to the results of Training Leader’s Medical Practice Top Challenges Survey. Read on to see how you stack up to your[...]

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medical collections front desk helping patient
5 Tips to Prevent Unpaid Medical Collections – Supercharge Your Staff

For years, deductibles were so low. Payers paid most of the patient responsibility on claim submission. Those days are obviously gone putting the onus on your practice’s medical collections to keep your revenue stream healthy. “Most patients maybe had a $250 or $500 deductible,” recalls medical collections expert Tracy Bird, FACMPE, CPC, CPMA, CEMC, CPC-I,[...]

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provider credentialing
New Provider Credentialing: Your Top 10 Questions — Answered!

Does even thinking about new provider credentialing give you a headache? Sure, you’re anxious for new providers to start generating revenue for your practice. But you’re also dreading those long, complicated forms that are so easy to mess up. Credentialing is anything but simple. One misstep, and your practice’s revenue cycle will slow to a[...]

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Watch Out for These 11 Devious Payer Contracting Negotiation Tricks

How hard are your managed care contracts working for you? Could payer contracting even be working against you? Payer reimbursements are the foundation of your practice revenue, but unfavorable contract terms can cost you thousands of dollars. Many providers find payer contract negotiation — or renegotiation — to be a complex and even uncomfortable task,[...]

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abn form
Medicare’s ABN Form: Top 10 Mistakes You’re Making (and How to Fix Them)

Using Medicare’s ABN form, Advance Beneficiary Notice might be a routine part of your job, but are you sure you’re doing it correctly and compliantly? Providers and staff who treat Medicare patients must know exactly how and when to issue a CMS ABN form to avoid costly write-offs and penalties. If you’re like most providers[...]

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Tips for Getting Contracted into
Closed Payer Networks

Let’s begin with answering the question “What is are closed payer networks?” Closed Payer Networks Defined Closed payer networks are a payer network that currently have participating (par) providers, like you, and, therefore, is not adding more similar providers, including you, to their network. A narrow network means it has enough par providers of a[...]

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Payer Contract
6 Tips to Negotiate the Payer Contract You Want

Payer contract negotiations don’t have to be painful. Consider these action items to help keep you focused, avoid payer pressures, and prioritize your organizational goals to ensure the right outcomes for your practice: Basic housekeeping: Getting your ducks in a row before the process begins is essential to your success. One key item is to[...]

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TRICARE Transition
TRICARE Transition Clarification

TRICARE West region Effective January 1, 2018, the new Tricare West contractor will be Health Net Federal Services (HNFS). All Tricare West providers must secure new contracts with HNFS as UnitedHealthcare will no longer retain this contract. PGBA will remain the claims processor and there will be no disruption to electronic claim transmissions. The new[...]

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Modifier Choice
Modifier Choice Key in Boosting Payments for Bilateral Procedures

If you report bilateral procedures — and most practices do — how you tell your payers that you performed the same services on both sides of the body depends greatly on the payer itself. But there are some general tools and strategies you can follow that will point you in the right direction, and help[...]

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Medicare Claims Denied
Medicare Claims Denied For NCCI Edits

What do you do when an insurance payer denies a claim for NCCI edits, but it is contrary to the NCCI edits found on CMS’s website? Whose edit guidelines take precedence? When you are looking at NCCI verses a local coverage determination, the local coverage determination trumps the NCCI. One of the reasons for this[...]

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MACRA Final Rule Deadline
MACRA Final Rule Deadline: Submit Your Comments by Dec. 19

Although the Centers for Medicare and Medicaid Services (CMS) released the final rule under the Medicare Access and CHIP Reauthorization Act (MACRA) back in October, it’s still looking for feedback in certain areas affected by the regulation. You can still provide feedback and suggestions, but your time if running out. You must submit your comments[...]

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Denial Tracking
With Grace Period Over, Denial Tracking Is the Answer

On Oct. 1, you lost the ICD-10 reporting grace period that the Centers for Medicare and Medicaid Services (CMS) granted to help ease you into complying with the new diagnosis coding system. So, why should you care? For the past year, you’ve been receiving payments for claims that were coded close to the target.  All[...]

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ICD-10-CM Code
Laterality Frequently Unlocks ICD-10-CM Code Accuracy

To get your claims reimbursed, payers demand that you be as specific as possible with your ICD-10-CM code assignment. Often this means you must identify laterality and accurately adjust your coding to avoid claim denials and payer audits. When CMS implemented ICD-10, the number of diagnosis codes went from 14,000 to 68,000 — a massive jump.[...]

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