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Search Results for: Payer Contracting

ADA CAQH ProView: Dentist Payer Approval Faster & Easier
Feb 14, 2023 - 3:00 ET
Expert Presenter: Leslie Icenogle

Unfortunately, getting and keeping your dentists enrolled and credentialed in both commercial and government insurance plans is a necessary evil – even with the ADA CAQH ProView online portal. The American Dental Association (ADA) collaborates with the CAQH ProView portal to make enrolling and credentialing your dentists easier – to reduce the administrative burden of[...]

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Out of network billing laws
Comply w/Out-of-Network & Uninsured Patient Billing Rules
Mar 1, 2023 - 1:00 ET
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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ERISA Regulations
Keep More of Your Reimbursement, Make ERISA Work for You
Feb 23, 2023 - 1:00 ET

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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Telehealth Billing
Stop 2023 Telehealth Billing & Coding Errors to Keep Cash Flowing
Feb 21, 2023 - 1:00 ET
Expert Presenter: Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO

When done right, telehealth billing & coding can produce significant revenue for your practice. However, in 2023 there are multiple items that can halt your payments. Get proven tactics to successfully bill and code these services.

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CAQH profile
CAQH 2023: Utilize New Changes to Get Paid More Quickly & Easily
Feb 16, 2023 - 3:00 ET
Expert Presenter: Yesenia Servin CPMSM, PESC

2023 CAHQ ProView changes are a nightmare. Unfortunately, if you want to keep your practice’s revenue flowing, your provider’s CAQH profile MUST be kept accurate, active and in compliance. This expert-led training will help.

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IDR Process
Get Paid for Out-of-Network Denied Services with New Federal IDR Process
Feb 7, 2023 - 1:00 ET
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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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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Balanced billing laws
Stop Huge Penalties for Innocent Balanced Billing Law Violations
Expert Presenter: Heidi Kocher B.S., M.B.A, J.D., CHC

With a little help, you can comply with complex balanced billing laws, avoid a stressful audit and the massive violation penalties that can result. Stop making innocent mistakes that can lead to huge penalties and even jail time.

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

You must correctly incorporate the massive 2023 E/M changes to keep reimbursement flowing for prolonged services, ED visits and more. These expert, step-by-step coding tips will show you how.

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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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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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Incident to services
Get Paid 15% More, 2023 Split/Shared Change & 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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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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Physician credentialing
Stop 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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provider credentialing
Speed Up Payer Credentialing/Enrollment Responses & Approvals
Expert Presenter: Olga Khabinskay MBA

Any snag during the provider credentialing and enrollment process will slow down your ability to bill for your provider’s work and bring money into your practice. Discover the proven tips that can help you speed up the process.

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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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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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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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2022 E/M updates
Cut E/M Coding Confusion to Boost Office Visit Reimbursement
Expert Presenter: Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO

The 2022 E/M updates have added complexity to your billing process. This upcoming training will guide you through getting your claims right, reducing denials, and boosting payments.

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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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Medicare Appeals
Persuade Payers to Pay Up with Successful Appeals Process
Expert Presenter: Sean M. Weiss CHC, CMCO, CEMA, CPMA, CPC-P, CMPE, CPC

Quickly overturn more of your rejected claims with proven Medicare appeal strategies. The key is mastering the nuances of the Medicare appeal process by cutting through the government requirements. Find out how…

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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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CMS telehealth
Stop CMS Audits from Taking Back COVID Telehealth Payments
Expert Presenter: Amanda Waesch Esq.

Stop the Office of the Inspector General (OIG) from requiring you to give back the telehealth reimbursements you received during COVID from Medicare and Medicaid.  Auditor are targeting these claims to recoup overpayments.

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Coding for COVID testing
Cut Through COVID Testing Coding Confusion & Boost Pay-up
Expert Presenter: Stephanie Thomas CPC, CANPC

Properly coding for COVID testing is essential to getting paid what you deserve.  This training will help you more accurately code each COVID testing encounter right the first time, and to avoid over-coding and lost revenue.

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Payer contracting strategy
Get Higher-Paying Contracts with Proven Negotiation Strategies
Expert Presenter: Doral Jacobsen MBA, FACMPE

You can get payers to increase your rates if you know the proven tricks that help you engage insurers and win contract negotiations. This online training gives you the tools you need to secure higher rates and better terms.

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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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Remote patient monitoring
Get Paid More for Remote Patient Monitoring, 2022 Updates Key
Expert Presenter: Michael Stearns MD, CPC, CFPC, CRC

More accurately code your Remote Patient Monitoring (RPM) claims and protect your practice against auditors looking to recoup payer reimbursements. Expert strategies to overcome this year’s RPM confusing rules changes.

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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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Payer credentialing delegation
Payer Delegation: Speed Up Enrollment and Get Paid Faster
Expert Presenter: Amy M. Niehaus MBA, CPMSM, CPCS

Getting your mid-sized to large practice designated as a credentialing delegate with payers means you can eliminate enrollment delays, get paid faster, and avoid re-enrollment disasters.

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

Stop self-pay billing mistakes from leaving your practice exposed to serious financial and legal penalties. This training can help you protect your practice by complying with with confusing self-pay billing rules. Sign up today.

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Telehealth mental health
Stop Costly Telehealth Mental Health Billing Errors and Payer Audits
Expert Presenter: Stephanie Allard CPC, CEMA, RHIT

Payer auditors are closely scrutinizing telehealth claims, and mental health is at the top of the list. This training will help you audit proof your telehealth mental health claims and walk you through how to fix the ones  already filed.

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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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time-based coding guidelines 2021
Earn More Money for Time Based E/M Visits Without Getting Audited
Expert Presenter: Leonta Williams RHIA, CCS, CCDS, CPC, CPCO, CRC, CEMC, CHONC

Time based coding may make it easier to calculate the level of your office visit, but do it wrong and you’ll lose thousands in reimbursement and get audited. Find out how to make time based coding work for you.

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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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E/M Surgical Modifiers
2-Part Training: Master Modifiers: Expertly Avoid Misuse and Audits
Expert Presenter: Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO

Get expert advice to master E/M and surgical modifiers to get paid more of what you deserve and avoid getting audited and fined. This online training gives you practical advice you can put into action immediately.

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Surgical modifiers, surgical billing
Boost Surgical Modifier Pay-up and Avoid Audit Penalties
Expert Presenter: Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO

Don’t fall prey to CMS auditors intensely scrutinizing surgical modifier claims. They are digging to uncover recoupments (and earn commissions). Protect your practice, sign up for this step-by-step surgical modifier training today.

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E/M modifier
Avoid E/M Modifier Missteps: Make More Money with Less Hassle
Expert Presenter: Kim Huey MJ, CHC, CPC, CCS-P, PCS, CPCO

Applying E/M modifiers incorrectly can seriously cut your revenue, especially considering this year’s massive 2021 E/M changes.  Don’t file another E/M claim without ensuring you’ve got it right. Sign up for this online training today.

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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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Telehealth compliance audits
Stop Costly Fines from Telemedicine Billing Errors
Expert Presenter: Jeana Singleton JD

Payers report that they’ve overpaid for telehealth services. To combat this, auditors are picking through thousands of telemedicine claims to take back these overpayments. Find out how to protect your telehealth revenue.

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Provider Credentialing Tools
Head Off Provider Credentialing Headaches with Proven Tracking Tools
Expert Presenter: Tracey Tokheim

National expert provides easy-to-implement provider credentialing and enrollment tools to help you improve data accuracy and avoid lost reimbursement due to delays in applications, payer approval, and hospital privileges.

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Renegotiating Insurance Contracts
Renegotiate Payer Contracts to Boost Payup by 12%
Expert Presenter: Prerna Marwah MBA

Stop letting your payers dictate contract terms. Learn how to analyze and renegotiate your payer contract to improve your overall reimbursement, speed up payments and reduce surprise rate changes.

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Telehealth COVID-19
Telehealth Workflows: Improve Patient Care and Build Revenue
Expert Presenter: Donna Dittman Hale MHA, CTC

You’re going as fast as you can to implement telemedicine, but without the right technology and workflows, your daily operations will be much slower – and lower reimbursed – than they need to be.

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Negotiate Payer Contracts to Get Paid More of What You’re Due
Expert Presenters: Daphne Kackloudis Esq.; Ashley Watson Esq.

Learn how to more successfully negotiate and renegotiate your payer contracts to improve your practice’s reimbursement and volume of patient referrals. Two healthcare attorneys show you how.

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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,CRCS, 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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Prior Authorizations 101: A-Z Tactics to Get More Services Paid
Expert Presenter: Owen Dahl LFACHE, CHBC, LSSMBB

Expert prior authorization strategies to help you reduce your workload and improve your reimbursement. This A-Z training will help you identify areas you can improve within your current processes and your payments.

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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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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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Telehealth Claim Denial
Claim Denial Telehealth: Check 2 Items Before Refiling

QUESTION: We just received our first denial for a telehealth service using audio-visual. The claim was filed with office visit code 99212, place of service 02 for telehealth and modifier 95. Can you tell us what we did wrong so that we can get paid for these visits? Question from Palatine, Illinois Subscriber ANSWER: Based[...]

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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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CPT telehealth audits
Ace Telehealth Audits and Keep Your Reimbursements

Important: Your CPT codes 99201-99215 claims are under attack. CMS and private payers started their telehealth exam post-payment audits which include reviewing your records and contacting your patients. Address these telehealth audit targets right now so you can hold onto more of your office visit pay and prevent future compliance penalties. Telehealth Exams Must Include[...]

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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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Claim Denial Telehealth: Check 2 Items Before Refiling

QUESTION: How can we avoid denials for telehealth claims including modifiers? We just received our first denial for a telehealth service using audio-visual. The claim was filed with office visit code 99212, place of service 02 for telehealth and modifier 95. Can you tell us what we did wrong so that we can get paid[...]

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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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