Book a FREE Training Consult TODAY Learn More

Filter and Search

Search Results for: Payer Contracting

product
Payer Audit Response
Respond to Payer Audits with Confidence & Reduce Recoupments
Sep 10, 2026 - 1:00 ET
Expert Presenter: Amanda Waesch Esq.

A payer audit notification can strike fear into the hearts of medical practices โ€” but it doesn’t have to. Discover how to respond effectively thanks to expert tips from a nationally-recognized healthcare attorney.

Learn More
Medicare secondary payer
Stop Medicare Secondary Payer Billing Mistakes Before They Cost Your Practice Thousands
Expert Presenter: Keisha Wilson CCS, CPC, CPCO, CPMA, CRC, CPB, AAPC Approved Instructor

Medicare Secondary Payer denials are among the top five denial reasons from Part B payers โ€” but they don’t have to be. This expert-led online training will help you cut MSP denials and collect faster.

Learn More
CAQH
Maximize Practice Reimbursement with CAQH ProView (DataSpring)
Expert Presenter: Olga Khabinskay MBA

Maximize your CAQH Proview (DataSpring) provider/practice accounts to get more patients, save on administrative costs and boost how quickly and accurately you get paid. Gain actionable tactics from this expert-led online training.

Learn More
Appeals Letters
Proven Appeal Tactics to Get More of Your Denials Paid
Expert Presenter: Christine Hall CHC, CPC, CDEO, CPB, CPMA, CRC, CEMA, CPC-I

You can get more rejected claims overturned, if you know what payers really want from your appeal letters. Let nationally recognized appeals expert Christine Hall provide you with the tools you need to get more of your claims paid.

Learn More
Physician credentialing
Provider Credentialing Tactics to Speed Up Approvals & Payments
Expert Presenter: Alina Mineyli

Get actionable steps you can put into place to ensure your provider credentialing applications move smoothly through the approval process, and help you jump into action if slowdowns occur. This online training shows you how.

Learn More
Pivot Table
Perfect Excel Pivot Table Know-How to Save Time & Boost Revenue
Expert Presenter: Nate Moore CPA, MBA, FACMPE

Your practice’s revenue depends on your ability to quickly, easily and efficiently track your data. Find out how to utilize Excel Pivot Tables to pin down hidden expenses and uncover revenue opportunities during his online training.

Learn More
Payor Contracting
Get Paid More With Proven Payer Contracting Tools
Expert Presenters: Jill Arena ; Kristin Bunch

You can get paid more for your payor contracts, if you know how. Attend this live online training to get Jill Arenaโ€™s proven payor contracting tools that will help your practice get paid more of what it deserves.

Learn More
Balanced billing laws
Stop Huge Penalties for Innocent Balanced Billing Law Violations
Expert Presenter: Amanda Waesch Esq.

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

Learn More
Onboarding a New Physician
Speed Up Credentialing & Reimbursement for New Providers
Expert Presenter: David J. Zetter PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

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

Learn More
NPPES 2025 Updates
Master New NPPES Registry Portal Changes to Keep Revenue Flowing
Expert Presenter: Tammy West MHA/ED, CPMSM, CPCS

You must master the new NPPES Registry Portal changes and data requirement updates to ensure that your providers continue to get paid. Conquer the numerous Portal changes with this practical, expert-led online training.

Learn More
Healthcare laws
Turn Healthcare Law into Revenue: Win Denials, Stop Recoupments & Protect Your Practice
Expert Presenter: Osato Chitou Esq. MPH

Join healthcare attorney Osato F. Chitou, Esq., MPH for a powerful training that shows you exactly how to use healthcare laws to your advantage โ€” to overturn denials, prevent audits from draining your revenue, and safeguard your practice from costly legal pitfalls.

Learn More
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.

Learn More
Payer Audit Response
Reduce Recoupments: Proven Responses to Payer Audit Notices
Expert Presenter: Amanda Waesch Esq.

A payer audit notification can strike fear into the hearts of medical practices โ€” but it doesn’t have to. Discover how to respond effectively thanks to expert tips from a nationally-recognized healthcare attorney.

Learn More
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 youโ€™re ready when Medicare auditors knock on your door.

Learn More
payers
Hold Payers Accountable: How to Stop Delays, Denials & Excuses
Expert Presenter: David J. Zetter PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

Get payers to abide by their contract promises to reduce payment delays, claim denials, authorization holdups, provider enrollment barriers, etc. Find out how. Sign up for this training presented by expert David Zetter.

Learn More
Medicare secondary payer
Halt Medicare Secondary Payer Denials & Get Paid More
Expert Presenter: Keisha Wilson CCS, CPC, CPCO, CPMA, CRC, CPB, AAPC Approved Instructor

Medicare Secondary Payer denials are among the top five denial reasons from Part B payers โ€” but they don’t have to be. This expert-led online training will help you cut MSP denials and collect faster.

Learn More
ERISA Regulations
Stop Payers from Taking Back Your Claim Payments with ERISA
Expert Presenter: David J. Zetter PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

About 83% of your non-Medicare/Medicaid claims are governed by ERISA regulations. However, payers donโ€™t want you to know how to apply these rules to take control of your reimbursement. This training shows you how.

Learn More
Terminate a Payer Contract
Terminate Payer Contracts Without Putting Your Practice at Risk
Expert Presenters: Daphne Kackloudis Esq.; Jordan Burdick JD

Terminating a payer contract might seem straightforward, but the minefield that follows can be a legal and regulatory nightmare. Protect your practice against the fallout by attending this expert-led 60-minute online training.

Learn More
Negotiation
Get Higher-Paying Contracts with Proven Negotiation Strategies
Expert Presenter: David J. Zetter PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

Donโ€™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.

Learn More
Copays
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.ย  Protect your practice against costly violations with the actionable tactics in this healthcare attorney-led online training.

Learn More
Locum tenens
Avoid Legal Missteps When Utilizing Locum Tenens Providers
Expert Presenter: Rachel V. Rose JD, MBA

Utilizing locum tenens providers can be a huge benefit to your practice. But it can also be a legal nightmare if you fail to comply with the complex rules.ย  Get how-to help from legal expert Rachel Rose during this training.

Learn More
Good Faith Estimate
Comply with Good Faith Estimate Complexities and Get Paid More
Expert Presenter: Amanda Waesch Esq.

With a few simple changes, you can streamline your Good Faith Estimate processes, head off compliance issues, negotiate higher payer rates and get paid more. Healthcare attorney Amanda Waesch, Esq., shows you how.

Learn More
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.

Learn More
Physician credentialing
Head Off Provider Credentialing Headaches with Proven Tracking Tools
Expert Presenter: David J. Zetter PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

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.

Learn More
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.

Learn More
Therapy Progress Notes
Stop Your Therapy Progress Notes from Triggering Payer Audits
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.ย  This training can help.

Learn More
ERISA
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.

Learn More
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

Learn More
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.

Learn More
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.

Learn More
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.

Learn More
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.

Learn More
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.

Learn More
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.

Learn More
ERISA
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.

Learn More
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.

Learn More
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.

Learn More
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.

Learn More
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.

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

Get paid more for treating patients with chronic pain โ€“ 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.

Learn More
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.

Learn More
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.

Learn More
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.

Learn More
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…

Learn More
ADA CAQH
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 youโ€™re working on at least[...]

Learn More
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.

Learn More
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 CMSโ€™ recently implemented IDR process. Get proven strategies to correctly utilize this new process to overturn these previously unpaid claims.

Learn More
CMS PECOS
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.

Learn More
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.

Learn More
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.

Learn More
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 claimsโ€™ reimbursement and decrease your financial and legal risk. Expert Owen Dahlโ€™s training will show you how.

Learn More
provider directory
Comply with New Provider Directory Validation Rules, Avoid Fines
Expert Presenter: David J. Zetter PHR, SHRM-CP, CHCC, CPCO, CPC, COC, PCS, FCS, CHBC, CMUP, PESC, CMAP, CMAPA, CMMP, CMHP

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.

Learn More
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 โ€” 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[...]

Learn More
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 โ€” 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.

Learn More
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 โ€“ before you get audited.

Learn More
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.

Learn More
Preauthorizations
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.ย  You can reduce the time they take and improve your overall approval rate with some expert help.

Learn More
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.

Learn More
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.

Learn More
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.  

Learn More
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.ย ย  Register for this expert-led online training today to find out how.

Learn More
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.

Learn More
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.ย  This expert-led online training will walk you through each step and help you head off lost patients by reactivating your contract.

Learn More
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 yearโ€™s massive 2021 E/M changes.ย  Donโ€™t file another E/M claim without ensuring youโ€™ve got it right. Sign up for this online training today.

Learn More
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 youโ€™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.

Learn More
Third-Party-Payer Appeals
Third-Party-Payer Appeals: Get Paid More of What Youโ€™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.

Learn More
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.

Learn More
Patient-Recall-Strategies-That-Work
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 revenueโ€ฆ

Learn More
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 doesnโ€™t have to beโ€ฆ

Learn More
Billing-From-A-to-Z-Improve-Claims-Pay-Up
Billing Strategies to Improve Your Claimsโ€™ 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 ultimatelyโ€ฆ

Learn More
Protect-Against-Payer-Aduit-Violations
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 youโ€™ll get audited has increased. Auditors can dig through your previously filed claims for a โ€œlook back periodโ€ of 6 YEARSโ€ฆ

Learn More
woman3
Get Closed Insurance Panels to Open Their Doors
Expert Presenter: Steve Selbst

Open the doors of those “closed” and โ€œnarrowedโ€ insurance panels that will most benefit your practice. Donโ€™t walk away from payers when they deny you access to the patients you want. Use these proven tactics to get…

Learn More
post
caqh provider
Medical Credentialing Is More Than Paperwork โ€” Itโ€™s Revenue Protection

…can be billed in-network, create a payer-by-payer readiness checklist. Document credentialing status, enrollment status, effective date, group affiliation or reassignment, and confirmation from the payer. Make Accurate Provider Data a…

Learn More
IDR Process
4 Steps to Prepare Your Team for the IDR Overhaul

…the cost-benefit calculation entirely. For years, the $115-per-party fee made low-dollar claim disputes a losing proposition before the process even started. If a payer underpaid a $200 claim, spending $115…

Learn More
Increase Medicare Advantage Pay-up
Stop Medicare Advantage Claim Denials: Practical Steps to Protect Your Practice Revenue

…payer rules, you’re not alone. Many physician practices face these challenges as MA enrollment grows nationwide. The good news: when you understand payer expectations, strengthen documentation, and follow good-faith billing…

Learn More
Modifier 25 billing
How to Identify and Fight E/M Downcoding to Protect Your Practice Revenue

…services, payer integrity programs frequently focus their automated review efforts on these claims. Many payers now use layered review systems that combine automated edits, machine learning models, natural language processing…

Learn More
ERISA Regulations
Win More ERISA Appeals: Why the Summary Plan Description Is Your Secret Weapon

…they’re paying claims directly out of their own pocket. The carrier is essentially renting out their network and processing paperwork. They’re an administrator, not the actual payer. That distinction matters…

Learn More
2026 ICD-10
How the 2027 ICD-10 Update Could Impact Your Medical Practice Revenue

…for outpatient and professional claims and the discharge date for inpatient services. Using an outdated code after the implementation date can trigger immediate clearinghouse rejections and payer denials. For physician…

Learn More
cybercrime
Hidden Cybersecurity Risks Threatening Your Medical Practice

…payer or a clearinghouse vendor is extremely difficult to distinguish from a legitimate message — especially when your biller is processing hundreds of claims a day under deadline pressure. One…

Learn More
NPPES Credentialing Portal
Credentialing Is No Longer Administrativeโ€”It’s Revenue Protection

…only reliable way to bypass payer delay triggers and keep revenue flowing on schedule.” As you tighten up your internal processes, the next challenge is what happens on the payer…

Learn More
CMS Physician Fee Schedule
What the 2027 Medicare Physician Fee Schedule Means for Your Practice

…Training Leader’s 3-Month All-Access Training Pass, your entire team receives unlimited access to hundreds of expert-led trainings covering Medicare reimbursement, billing and coding updates, compliance requirements, payer contracting, telehealth regulations,…

Learn More
MIPS Virtual Group
How Better Staff Meetings Can Increase Revenue and Reduce Administrative Waste

…claim denial trends Aging accounts receivable Prior authorization delays Coding accuracy concerns Documentation deficiencies Patient collection performance Compliance updates Payer policy changes These discussions directly affect your practice’s revenue and…

Learn More
OIG Audit
Build an OIG Compliance Program That Protects Your Medical Practice

…Inspector General (OIG), Medicare contractors, and commercial payers all use sophisticated analytics to identify unusual billing patterns and potential compliance concerns. Fortunately, you don’t have to overhaul your entire practice…

Learn More
Billing-From-A-to-Z-Improve-Claims-Pay-Up
How to Improve the Medical Claim Life Cycle and Reduce Claim Denials in Your Practice

…Payer Adjudication Learn Why Claims Get Denied When payers process claims, they compare submitted information against coverage policies and medical necessity rules. Claims may be: Paid Rejected Denied Pended for…

Learn More
Modifier 59
6 Steps to Master Medical Coding Modifiers & Stop Losing Revenue

…Medicaid, and commercial payers don’t all follow the same modifier logic. Some payers restrict Modifier 59 use to specific audit scenarios. Check each payer’s policy manual before finalizing the claim….

Learn More
Revenue cycle management
The Revenue Cycle Mistakes Quietly Costing Medical Practices Thousands

…today’s healthcare environment, tighter reimbursements, rising patient balances, and increased payer scrutiny mean your revenue cycle can either strengthen your practice—or quietly drain it. The good news is that most…

Learn More
Medicare secondary payer
How to Bill Medicare Secondary Payer Correctly and Avoid Costly Claim Denials

…no no field_60a298f4110c3 field_5d261ad51e5f8 22083 Medicare Secondary Payer billing How to Bill Medicare Secondary Payer Correctly How to Bill Medicare Secondary Payer Correctly Learn how Medicare determines primary versus secondary…

Learn More
Non-compete agreement
Medical Record Signature Requirements Every Practice Must Follow

…windows payers require. Step 3: Audit for Timeliness and Amendments Authentication isn’t just about who signed — it also concerns when. Before you lock a record for billing, you need…

Learn More
Time-Based Coding
Master E/M Time-Based Coding: Next-Day Results & Multi-Day Encounters Explained for Your Practice

…results were received Time spent reviewing them Your clinical interpretation Actions taken (med changes, follow-ups, referrals) Without this level of detail, payers may deny the claim or question medical necessity….

Learn More
Healthcare Compliance Program
3 OIG Compliance Strategies to Protect Your Practice

…compliance plan annually. Train every employee—not just coders and billers. Monitor billing trends before payers identify them. Strategy 1: Automate OIG Exclusion Screening One of the easiest compliance improvements you…

Learn More
caqh provider
How to Build an Accurate DataSpring (Formerly CAQH) Profile That Helps You Get Paid Faster

…proven best practices, you can reduce credentialing delays, improve payer communication, and make sure your providers are ready to participate with insurance networks as quickly as possible. Start With Accurate…

Learn More
HIPAA compliance
Outdated Compliance Processes Are Holding Your Medical Practice Back

…and payer enrollment. Incomplete employee training documentation can create problems during audits. Poor communication between departments often causes preventable compliance failures. According to the Centers for Medicare & Medicaid Services…

Learn More
Use Time Limits to Keep Meetings Productive

…provider documents incomplete medical necessity. Coding doesn’t receive clarification before the claim is submitted. A prior authorization expires because no one followed up. A payer policy change isn’t communicated to…

Learn More
ABN
New ABN Form Required in 2026: How to Prevent Medicare Denials and Protect Your Revenue

…Your Practice Faces Mastering ABNs is just one piece of protecting your practice’s revenue. Today’s medical practices are facing constant changes to Medicare rules, payer requirements, coding regulations, compliance mandates,…

Learn More
Outsourced medical billing
How to Successfully Outsource Medical Billing and Strengthen Your Revenue Cycle

…management, revenue cycle optimization, payer contracting, and more. Get practical guidance your entire team can implement immediately to improve collections, reduce administrative burdens, and increase profitability.   1781883993:13615 13615 240920…

Learn More
CAQH
7 Ways to Simplify Your Credentialing Process with CAQH

…practice locations, malpractice insurance details, and required disclosures. Every field matters. Incomplete profiles do not just slow down payer access; they block it entirely. Payers cannot pull data from a…

Learn More
IDR Process
How to Win More Payment Disputes Under the New Federal IDR Process

…administrative dismissals or delayed reimbursement. Staff members should routinely verify payer information, maintain complete claim documentation, and ensure all records align with federal submission requirements. Investing in ongoing revenue cycle…

Learn More
CPT Code Changes
Most Medical Practices Underuse ICD-10 Z Codes โ€” Hereโ€™s Why That Matters

…Matter More in Value-Based Care Healthcare reimbursement is no longer based only on the volume of services provided. Payers increasingly evaluate medical practices based on outcomes, quality metrics, risk adjustment,…

Learn More
MACRA Compliance
Why โ€œCheck-the-Boxโ€ Compliance Training Is Putting Your Practice at Risk

…Even when intent is not present, patterns of waste or abuse can still trigger payer scrutiny. Teaching your team these distinctions helps them recognize risks before they escalate. Know the…

Learn More
2026 HCPCS
39 New HCPCS Codes Are Coming: Is Your Practice Ready?

…Medicare and other payers, document medical necessity, and manage your revenue cycle. By preparing early, you can reduce compliance risks and position your practice for smoother claims processing and stronger…

Learn More
PECOS Surrogacy
Medicaid Eligibility Verification Mistakes That Hurt Reimbursement

…both Medicare and Medicaid present unique billing challenges. Medicare typically serves as the primary payer, while Medicaid functions as the secondary payer. If Medicare claims are not processed correctly or…

Learn More
Billing modifier 62
The Hidden Revenue Leaks in Global Surgical Billing (And How to Fix Them)

…leads to underbilling, denied claims, and lost revenue. The reality? Most practices leave money on the table simply because documentation and modifier usage don’t align with payer expectations. Learn exactly…

Learn More
Protect Your Practice from Fraud, Waste and Abuse Violations

…care while remaining compliant with Medicare, Medicaid, and commercial payer requirements. Compliance Is Everyone’s Responsibility The strongest compliance programs are built on a culture where every employee understands their role…

Learn More
Childrenโ€™s medical records
Top 10 Medical Records Strategies to Avoid Denials, Fines, and Legal Trouble

…practice to risk. Action Step: Separate minor records in your system and apply extended retention rules automatically. Are You Following Payer Contract Requirements? Many payer contracts include specific record retention…

Learn More
downcoding-high-level-em
Why Your Level 4 and 5 E/M Claims Are Being Downcoded

…Provider-specific downcoding trends Documentation weaknesses Payer-specific issues Internal audits can dramatically improve reimbursement accuracy while reducing compliance exposure. How to Respond When Claims Are Downcoded If a payer improperly downcodes…

Learn More
Medicaid Audit
Medicaid Fraud Enforcement Is Getting More Aggressive โ€” Hereโ€™s What You Need to Know

…systems. The government is no longer waiting for whistleblower complaints or payer disputes to uncover problems. Instead, agencies are proactively using billing data, utilization trends, EHR records, and artificial intelligence…

Learn More
Angry patient
Front Desk Phone Tips to Protect Your Revenue

…payer information, your practice risks claim denials, billing delays, and frustrated patients. Insurance verification mistakes frequently create revenue cycle problems that impact the entire office. Incorrect patient demographics or insurance…

Learn More
Oig report
OIG Audit Priorities You Should Be Monitoring

…that many physician practices are too busy handling staffing shortages, reimbursement cuts, payer denials, and operational fires to actually monitor those warning signs. That is exactly why the HHS Office…

Learn More
E/M Downcoding
Detect and Stop E/M Downcoding by Insurance Payers (Before It Costs You Thousands)

…more time on appeals, your cash flow slows down, and provider frustration increases. How Downcoding Actually Works (What Payers Are Looking At) Algorithm-Driven Claim Reviews Payers use proprietary algorithms to…

Learn More
Medicare Advantage Overpayments
Medicare Advantage Compliance: Why Physician Practices Need to Take Action Now

…common, which can create operational headaches for providers and staff. Your practice should not simply accept denials without review. Instead: Track denial patterns Monitor repeated payer behavior Appeal inappropriate denials…

Learn More
Medicare Overpays
Patient Refund Rules Are Changing: What Your Practice Needs to Know Now

…Also Matter Your payer contracts often include specific rules about handling overpayments. If you ignore these requirements, you risk recoupments, contract violations, or even termination. You should regularly review payer…

Learn More
Fraud, Waste, and Abuse in Medical Practices: Can You Pass This Compliance Check?

…(Hint: It’s Not Your Vendor) Your clearinghouse doesn’t own your claims. Your payer doesn’t own your claims. The provider does. According to CMS billing guidance, providers are responsible for ensuring…

Learn More
Appeals COVID waivers
Denied Medical Claims? How to Write Effective Appeal Letters That Work

…of medical necessity. To overturn these: Show symptoms and functional limitations Include diagnostic evidence Document failed conservative therapy Align with payer policies Your argument should directly match the payer’s coverage…

Learn More
10 Warning Signs AI Is Downcoding Your E/M Claims

…E/M downcoding. Payers are increasingly using automated claim review systems, predictive analytics, and artificial intelligence tools to evaluate Evaluation and Management (E/M) claims. While automation may improve payer efficiency, it…

Learn More
pecos-medicare-enrollment
CMS Requires New HETS EDI Attestation for Providers

…missing eligibility information, or incorrect payer coordination details. This creates avoidable claim denials, rework, and delayed payments. Your billing team may also spend hours manually researching eligibility issues that could…

Learn More
Pecos enrollment
How the Medical Credentialing Process Actually Works (and How to Avoid Delays)

…resolving discrepancies early—can help prevent unnecessary delays. Payer Enrollment (Where Revenue Actually Starts) Credentialing alone does not get you paid—you must also complete payer enrollment. This is the step where…

Learn More
Medical Appeal Letters Made Simple: 10 Smart Strategies to Win More Claims

…handle higher volumes of denials efficiently. When used correctly, templates improve consistency while reducing staff burnout. Stay Compliant with Legal & Payer Requirements Ignoring payer rules can cost you—big time….

Learn More
Using modifier 25
Modifier 25 Errors That Are Costing Your Practice Thousands

…Payers Expect (and Audit For) Payers—including CMS and private insurers—are actively auditing Modifier 25 usage. Programs like CERT and Targeted Probe and Educate (TPE) specifically review E/M billing accuracy. The…

Learn More
Mental Health Client Boundaries
2026 Mental Health Parity (MHPAEA) Rules: Push Back on Denials

…— not your practice. However, the law gives you leverage. When a payer’s policies create barriers to mental health treatment that aren’t applied equally to physical health services, those policies…

Learn More
Credentialing providers at multiple locations
Provider Credentialing Mistakes That Are Costing Your Practice Thousands

…onboarding Improved cash flow Fewer claim denials Better compliance Stronger payer relationships Credentialing efficiency also supports network participation and expansion. CMS and payer systems rely on accurate provider data to…

Learn More
Front Desk Collections
8 Front Desk Collection Strategies to Boost Your Practice Revenue

…— and your revenue — up for failure. When your staff understands payer basics, they can: Answer patient questions with confidence Capture accurate demographic and insurance information Build trust and…

Learn More
Workplace bullying
Why Your POS Code 22 Billing Is Getting Denied and What to Do

…should: Review payer-specific billing guidelines regularly Confirm POS requirements for telehealth and outpatient services Train your team on payer differences If you assume all payers follow the same rules, you…

Learn More
No surprise billing act
Get Paid What You Deserve Using the IDR Process for Medical Billing

…depends on how effectively you handle payer disputes. That’s where the Independent Dispute Resolution (IDR) process comes in. It gives you a structured way to challenge underpayments and fight for…

Learn More
Patient collections
Fix Front Desk Collections Before They Become a Billing Problem

If your team is sending large patient balances to statements, you’re already behind. The biggest shift in healthcare revenue isn’t payer behavior — it’s patient responsibility. More of your revenue…

Learn More
Medicare credentialing
Master Provider Licensure and Primary Source Verification in Your Practice

…it incorrectly, you risk: Hiring unqualified providers Failing audits Losing payer contracts Facing legal and financial penalties PSV is not optional—it is a compliance requirement and a risk management strategy….

Learn More
Telehealth Claim Denial
After Insurance Denials: When You Can Bill Patients (and When You Canโ€™t)

…compliance strategies with the All-Access Pass.   1774457751:13615 13615 179419 no no field_60a298f4110c3 field_5d261ad51e5f8 22083 healthcare payer audit response How to Respond to Healthcare Payer Audits Healthcare payer audits are…

Learn More
Practice Management
The Simple Way to Increase Revenue Using Your Practice Data

…Revenue by Payer You can start with one of the most important financial questions in your practice: Which payers are actually paying you—and how well? Here’s how to build a…

Learn More
TELEHEALTH_PLACE_OF_SERVICE
Think Youโ€™ve Mastered Place of Service Codes? Take This Quick Billing Reality Check

…practical strategies by watching the Improve POS Coding training.   1774894640:13615 13615 207275 no no field_60a298f4110c3 field_5d261ad51e5f8 22083 healthcare payer audit response How to Respond to Healthcare Payer Audits Healthcare…

Learn More
HIPAA and Telehealth
Hidden Telehealth Billing Mistakes Costing Practices Revenue

…necessity. Always confirm payer acceptance before billing. โœ” Apply telehealth modifiers properly Modifier -95 typically indicates synchronous telehealth services with audio-video interaction. Some payers require additional modifiers or documentation. โœ”…

Learn More
Appeal letter
Responding to Payer Audit Letters: Protect Your Revenue and Stay Compliant

…  1774457154:13615 13615 219766 no no field_60a298f4110c3 field_5d261ad51e5f8 22083 healthcare payer audit response How to Respond to Healthcare Payer Audits Healthcare payer audits are increasing in 2026, making proper audit…

Learn More
Provider Enrollment and Credentialing
How to Get Providers Approved Faster, Stay Compliant, and Protect Revenue

…payers, claims can be denied, payments delayed, or billing privileges revoked. CMS continues to enforce strict screening, verification, and reporting requirements under the Medicare provider enrollment regulations (42 CFR §…

Learn More
Destruction of medical records
Medical Record Retention Mistakes That Could Cost Your Practice Thousands

…necessity. Without this documentation, your claims may be denied or recouped during audits. A well-written policy also creates consistency across your team and ensures you can respond quickly to payer…

Learn More
CMS QAPI requirements
What the CMS QAPI Changes Mean for Your Medical Practice

…strong QAPI program helps identify problems early and implement sustainable solutions. Over time, these improvements can lead to fewer patient complaints, fewer claim denials, and stronger payer relationships. Why CMS…

Learn More
Place of service codes
Stop Losing Revenue from Incorrect Place of Service Codes

If your practice submits claims to Medicare or commercial payers, selecting the correct Place of Service (POS) code is essential. One small coding error can trigger claim denials, payment reductions,…

Learn More
medical practice performance reports
How Monthly Practice Reports Help You Get Paid More and Run Better in 2026

…and operations teams use them to see how schedules, productivity, and payer behavior affect outcomes. When your reports are shared across the practice, everyone understands the true impact of their…

Learn More
Modifier 25 billing
Modifier 25: How to Use It Correctly, Avoid Denials, and Protect Practice Revenue

What Modifier 25 Means (And Why It Matters for Your Practice) Modifier 25 tells payers you provided a significant, separately identifiable Evaluation & Management (E/M) service on the same day…

Learn More
medical billing training for staff
How Training Your Billing Staff Directly Increases Revenue and Reduces Claim Denials

If your practice is struggling with denied claims, delayed payments, or unpredictable cash flow, the issue often isn’t your EHR or your payer contracts — it’s training. Billing rules, payer…

Learn More
Modifier 25 billing
How to Protect Revenue When Billing E/M Services with Preventive Visits

…on medical necessity, documentation, and whether the service is truly “significant and separately identifiable.” If you get this wrong, you risk denials, recoupments, patient billing complaints, and even payer scrutiny…

Learn More
balance billing compliance
Balance Billing Compliance: How Your Medical Practice Avoids Penalties, Patient Complaints & Revenue Loss

…trigger payer review or regulatory inquiry. Practices with strong documentation, signed disclosures, and updated financial policies resolve issues more smoothly. Your best defense is proactive compliance — not reactive correction….

Learn More
Insurance claim denials
How to Fight Insurance Claim Denials and Turn Healthcare Laws Into Revenue

…that reality helps your team stop blaming themselves — and start responding strategically. How Payer Interference Impacts Patient Care and Staff Burnout When payers delay or deny claims, your staff…

Learn More
E/M downcoding
Stop Losing Thousands: How E/M Downcoding Is Draining Your Practice Revenue in 2026

…single downcoded visit may reduce reimbursement by tens or hundreds of dollars, depending on payer contracts. When this happens repeatedly — across multiple providers and payers — the cumulative loss…

Learn More
payer audit reimbursement appeals
How to Survive a Payer Audit and Win Your Reimbursement Appeals

…knowing what payers expect, how to document correctly, and how to defend your claims with confidence. Why Payer Audits Are Increasing — and Why Your Practice Is a Target Payers…

Learn More
telehealth documentation requirements
Telehealth Documentation Requirements in 2026: How to Stay Compliant and Get Paid

…support eligibility, billing accuracy, and medical necessity for virtual services. When your team follows consistent documentation standards across Medicare, Medicaid, and commercial payers, you protect reimbursement while maintaining compliance. Document…

Learn More
medical practice reimbursement
How Your Medical Practice Really Gets Paid โ€” And What You Can Do to Increase Reimbursement

…on increasing reimbursement through smarter payer contracting. In this training, you’ll discover: Where payer contracts quietly limit reimbursement How to strengthen your negotiating position What documentation and data payers expect…

Learn More
NPPES Credentialing Portal
How to Use the NPPES Portal Correctly (and Avoid Credentialing Delays)

If your practice bills insurance, enrolls providers, or participates in Medicare, Medicaid, or commercial payer networks, the NPPES portal plays a critical role in whether your claims get paid. When…

Learn More
telehealth
DEA Extends Telehealth Controlled Substance Prescribing: What Your Practice Must Do in 2026

…compliance in 2026. Billing requirements, payer policies, and documentation standards continue to evolve. Get complete 2026 telehealth billing and compliance guidance by watching this on-demand training. This training helps ensure…

Learn More
Evaluation and Management
What Your Practice Must Do Now to Get Paid for 99470, 99445, and RPM Services

…wrong device code can result in underpayment or recoupment. Always confirm payer-specific guidance, especially for Medicare Advantage plans. How to Combine RPM with CCM and E&M—Without Risk RPM services may…

Learn More
Telehealth
Telehealth Is at a Turning Point โ€” What This Means for Your Medical Practice

…how you schedule patients, bill payers, document visits, and maintain continuity of care. That uncertainty is why the American Medical Association (AMA) is pushing lawmakers to make pandemic-era telehealth rules…

Learn More
2026 Medicare Fee Schedule
Navigating the 2026 Medicare Fee Schedule: What Your Practice Must Do Now to Protect Revenue

…payer processing mistakes early in the year and must actively audit remittances instead of assuming accuracy. Action for staff: Create or update a provider list that clearly identifies QP vs….

Learn More
cms complaint form
Using the New CMS Complaint Form: What Medical Practice Staff Need to Know (and When to Use It)

…so does the volume of prior authorization requests, claim scrubbing requirements, and payer-specific rules your team must follow. When MA plans: Delay care Misapply payer policies Create excessive prior authorization…

Learn More
claim denials
Guaranteed Ways to Slash Claim Denials and Strengthen Your Revenue Cycle

…These issues typically happen because information was missed, documentation was incomplete, or payer rules weren’t followed exactly. Understanding these root causes is the first step to fixing them. The most…

Learn More
Expert Tips to Speed up the Provider Credentialing Process

…copies and not originals. Follow up Frequently If the provider credentialing process seems to be moving slowly, get the contact information for someone at the payer’s office and follow up…

Learn More
How to Prevent the 3 Most Common Medical Claim Denials

…confirm before performing these services and billing them to your payer. Confirm Which Payer is Primary More than 6,000 denials happen every year at CGS Medicare because the wrong payer…

Learn More
Aetna Softens New Medicare Advantage Downcoding Policy

Another day, another downcoding policy to grapple with. And while that’s unfortunately the reality in today’s healthcare world, the latest news from Aetna isn’t all bad. The payer has issued…

Learn More
Outlier
How to Respond if Your Payer Says Youโ€™re an โ€˜Outlierโ€™

…or seeing your claims downcoded. Not every outlier letter means you’ll face lost revenue, but it can still be upsetting. Check out a few steps to take if your payer…

Learn More
EM services
3 Commonly Downcoded E/M Services & How to Avoid Issues

…encounter for code selection, 40 minutes must be met or exceeded) is among the codes that Cigna has targeted for automatic downcodes in certain instances. Payers will reimburse about $155…

Learn More
Internal audit
5 Keys to Internal Audit Success at Your Medical Practice

…records, billing and coding practices, claims, documentation and payer reimbursement (if the audit is retrospective). Look for correct use of coding and detailed patient documentation as you perform the audit….

Learn More
Claims hold
Identify Which Services the Medicare Claims Hold Will Impact

…payable after the government reopens, then your payer will reimburse you for these visits after the claims hold is lifted. If CMS’ claims hold is taking a bite out of…

Learn More
E/M downcoding
3 Elements Your Appeal Letters Are Missing and How to Fix Them

…you’re appealing. Right near the beginning of the letter you’ll want to tell the payer why you believe they denied your claim incorrectly. Common reasons for appealing include: The payer’s…

Learn More
Billing errors
5 Little-Known Billing Errors That Cost Your Practice Big Money

…appeal with the correct information, but your best bet is to ensure you don’t have these problems up front. Missing the Filing Deadline Missing your payer’s filing date by just…

Learn More
2026 ICD-10-CM
5 Steps to Prepare for the 2026 ICD-10-CM Code Set

…Up Claims Reviews This is a good time to launch prospective claim reviews, meaning you scrutinize your claims before sending them to your payer. This gives you a chance to…

Learn More
E/M Downcoding
Cigna Releases 3 New Facts About E/M Downcoding Policy

Cigna’s new E/M downcoding policy — which will apply to certain high-level E/M claims — takes effect next week. And as the Oct. 1 implementation date approaches, the payer has…

Learn More
PAHCOM
The Lifelong Value of Professional Certifications in Practice Management

…invaluable—it’s about sharing insights that directly impact your work. A quick forum thread on handling payer denials, for example, could save your practice time and money. Organizations like PAHCOM foster…

Learn More
Medicare fraud
3 Steps for Reporting Fraud, Waste & Abuse at Your Practice

…what happened. They’ll work with you to identify how many claims were affected, how much money you’ll need to reimburse to the payer, and how to go about self-reporting the…

Learn More
Telehealth CPT
How to Choose Telehealth CPT Codes: 98000-98007 vs. E/Ms

…payers, you’ll submit one of the CMS-covered telehealth codes. For instance, you can report an established patient E/M visit performed over telehealth with a code from the 99211-99215 series, depending…

Learn More
CMS Fraud Waste and abuse training
3 Tips for CMS Fraud, Waste and Abuse Training Compliance

…If CMS or another payer asks for proof that you complied with the training requirements, you’ll need to have the documentation readily accessible. This means storing it in your practice…

Learn More
copay
Copay Collection Strategies to Keep Your Practice Thriving

…the same insurer, their copayments may not be the same because of the contract their employer has with the payer. Plus, the copay may be waived for certain preventive services,…

Learn More
Rank Your Insurance Payers to Evaluate Which Stay, Which Go

…each category. Any payer that falls outside of the average should be contacted. For instance, if your average payment speed is 30 days, but Payer A is taking 56 days…

Learn More
Are Revenue Cycle Bottlenecks Costing Your Practice Thousands?

Dr. Lopez’s busy orthopedic practice submits hundreds of claims every week. But with denials creeping up, the billing team is constantly resubmitting claims. One front-desk employee, unfamiliar with payer rules,…

Learn More
Staff compensation
HR Takeaways From MGMAโ€™s 2025 Staff Compensation Report

…the roles of staff members who take care of payer operations and finances. Nursing Staff Pay Soars Practices also needed more incentives than ever to hire and retain nursing staff…

Learn More
Courtesy Discounts
Meet These Conditions to Offer Professional Courtesy Discounts

…laws and payer contracts. In some cases, you’re perfectly within your rights to offer professional courtesy discounts. Keep these rules in mind as you navigate your path. Don’t Offer Discounts…

Learn More
Medicare secondary payer
Protect Medicare Secondary Payer Reimbursement: Key Tips

…out a few key strategies that will help you preserve your Medicare Secondary Payer reimbursement. What Is Medicare Secondary Payer? When Medicare isn’t the primary payer for a patient’s healthcare…

Learn More
99459
Cigna to Halt 99459 Pay With E/Ms: How to Weather the Change

…new patient; 65 years and older) as well as +99459. Track Payer Policies You may also still be able to report 99459 with E/M codes for payers besides Cigna. Always…

Learn More
Incident to billing guidelines
Sidestep 3 Compliance Issues: Follow Incident to Billing Guidelines

…is in the hospital, the concept of incident to doesn’t apply. “Hospital and skilled nursing facility services cannot be billed as incident to at any time,” says Part B payer…

Learn More
Revenue leakage
3 Types of Revenue Leakage That Cost Your Practice Thousands

…the payer. For instance, “I’m afraid your insurance company requires us to collect copayments at the time of service.” Or if the patient asks you if they can figure out…

Learn More
APCM codes
Check These Expert Ways to Get Paid for the New APCM Codes

…get paid for the new APCM codes that Medicare payers began accepting this year. 1. You Must Have Documented Consent Before you begin performing APCM services, you need to get…

Learn More
Financial hardship
When Can You Offer Financial Hardship Discounts to Patients?

…your payer contract to write off copayments — so what can you do? Check out what the law says, and when you can and cannot offer financial hardship discounts to…

Learn More
Medicare appeals
3 Times Medicare Appeals Arenโ€™t Accepted & What to Do Instead

…to that payer. 3. The Person Handling Medicare Appeals Isn’t Authorized Medicare claims can only be filed by people with a financial interest in the claim. This includes the patient,…

Learn More
Locum tenens
How to Use a Locum Tenens Modifier Correctly Every Time

…should bill the locum’s services using the NPI of the doctor that the locum is filling in for. Keep in mind that there are certain payers that may ask you…

Learn More
G0439
Can You Report Both G0439 and 99495 on the Same Date?

…NCCI does not include an edit bundling these two codes, which means Medicare payers should allow you to bill them together. Check What Payers Say You should always consult your…

Learn More
Payer contract
3 Considerations You Must Make Before Dropping a Payer

…LeadGenSKU 1745499419:44988 44988 253331 no no field_60a298f4110c3 field_5d261ad51e5f8 22083 Payer contract 3 Considerations to Make Before Dropping a Payer Terminating a payer contract may need to be done once in…

Learn More
Telehealth documentation
5 Must-Haves in Your Telehealth Documentation for 2025

…Patient Informed Consent Nearly every payer you’ll be billing in 2025 has a requirement that you get consent from the patient before performing your services over telehealth. Once the patient…

Learn More
G0556
Master New APCM Codes G0556-G0558 for Medicare Services

…but since only one of them is billing G0556 in a single month, the Medicare payer should still reimburse the practice for the care. You’ll collect about $15 for G0556,…

Learn More
Contract negotiation
3 Payer Contract Negotiation Pitfalls Every Practice Must Avoid

…may look like, and will give you stronger negotiating power when you get to the table with your payers. 2. Accepting Unclear Contract Terms Payers go out of their way…

Learn More
OIG audit
5 OIG Audit Areas Your Practice Must Ace to Stay Compliant

…the claim amounts and may even be subject to fines and penalties. For instance, if you submit a claim for removing impacted cerumen but the payer reads your documentation and…

Learn More
Front desk
3 Common Front Desk Mistakes โ€” and How to Avoid Them

…in submitting claims to outdated, expired or lapsed health insurers. By the time you realize you sent a claim to the wrong payer, the patient is gone and you can’t…

Learn More
Medicare credentialing
3 Processes to Help Speed up Medicare Credentialing

…Medicare credentialing applications through the system quickly. 1. Develop a Check-in Schedule Most payers will share their average processing time for complete Medicare credentialing applications, and once you get that…

Learn More
Medicare revalidation
Avoid These 3 Revalidation Mistakes Practices Often Make

Most providers must go through the Medicare revalidation process every five years, and if you don’t do it correctly, you could seriously harm your ability to collect from Medicare payers….

Learn More
Medicare credentialing
Overcome Medicare Credentialing Issues That Slow Enrollment

…to ensure the payer doesn’t need more information from you. Always track the application and confirm that it’s moving through the process well. 5. Failing to Follow Up on Requests…

Learn More
erisa
How ERISA Can Help Back Up Some Timely Filing Denials

…office staff then thinks these deadlines are written in stone. But the reality is that the insurer maintains these tight deadlines because they’re favorable to the payer, not to your…

Learn More
Place of service codes
Tips for Using Place of Service Codesโ€”Including the Newest One

…should submit their Medicare claim using POS 66. Place of Service Codes Affect Reimbursement Your payer may adjust the amount of reimbursement you receive based on which place of service…

Learn More
99443
Collect Top Dollar for 99443 When Performing Telehealth

When your provider talks to patient on the phone, you may worry that your payer won’t reimburse you appropriately for the visit, even though it takes just as much medical…

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

…Healthcare Practice Advisor. This field is hidden when viewing the form LeadGenSKU 1729471530:22818 22818 245685 1729471521 no no field_60a298f4110c3 field_5d261ad51e5f8 22083 Managed care contracting 8 Managed Care Contracting Strategies Lead…

Learn More
G2211 reimbursement
Some UHC Plans to Stop Reimbursing G2211: Will It Affect You?

…one payer wants to limit practices from collecting for this service in some circumstances. Read on to get the lowdown on how a new decision by UnitedHealthcare Commercial will change…

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

…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 learn a few lessons if…

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

…number(s) The patient’s payer ID number The patient’s date of birth 3. Share the Payer’s Own Policy The best way to support your appeal is to show the payer not…

Learn More
99211
99211 Documentation Checklist to Back Up Every Nurse Visit

…Must Be Face-to-Face Remember that reporting 99211 requires that the patient is established and that the encounter is face-to-face. Depending on the payer, “face-to-face” may refer to an in-person visit…

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

…so they shouldn’t be ignored. 5. Don’t Alter the Medical Records After Receiving the Audit Notice Never change the records before sending them to the payers. However, if there are…

Learn More
Telehealth services
Check These Essential 2024 Telehealth Modifiers for Faster Pay

…For your standard outpatient telehealth claims, CMS no longer requires modifier 95 to be appended to the corresponding CPT code. Keep in mind, however, that other payers may still want…

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

…seeing your prior authorization requests get denied, check out three tips that may help you improve your odds of success. 1. First, Read the Payer Policy From Beginning to End…

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

…and myriad other reasons. Your front desk team should be able to help patients walk through the EOB line by line to help them understand what the payer is trying…

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

…specific details within your claim that match the requirements within the payer policy. Sending an appeal letter that simply states, “This claim shouldn’t have been denied because we met your…

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

…demand letter, you should analyze whether the payer is correct in suggesting that you owe them money. Take a look at the claim in question, determine whether you really did…

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

…patient, that could raise a red flag with payers and auditors. This includes such examples as: Providers calling patients as an unplanned follow up within the same week as a…

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

…it rather than waiting for a payer to tell you what’s causing the delay. Payers will always push the envelope in terms of timelines and denials, so it’s up to…

Learn More
G2211
New G2211 Facts Help Guide Your E/M Reimbursement Strategy

…but NGS has clarified both those issues. “There are no frequency or duration limitations on G2211,” the payer said. “Medical necessity is the primary factor in considering the use of…

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

…Information It’s very important to take note of the contact information on the card, since many payers will have different phone numbers and claims addresses depending on where the patient…

Learn More
Write off
3 Patient Charges You Canโ€™t Write Off (and Some You Can)

…do not routinely waive or write off copays and deductibles. This type of conduct raises red flags and is likely to violate your payer contracts. Here’s why: The patient’s portion…

Learn More
G2211
Donโ€™t Look for G2211 Pay With Your E/Ms Until February

…Claims Now How you handle your claims for G2211 now will depend on whether you’ve already sent them to your payer or not, and whether you’ve seen denials. If you’ve…

Learn More
Transgender patient
4 Tips Help You Collect for Transgender Patient Services

…Modifier, Condition Code 45 Depending on your payer, even the above ICD-10-CM codes may not help you collect for your claim if the insurer has gender-specific edits in place. Therefore,…

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

…payer can request is to investigate who’s asking. Although this may seem simple, the reality is that insurers often ask third-party organizations to do their audits for them. For instance,…

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

…RT and LT Modifiers For Bilateral Procedures In some situations, your provider may need to tell payers where on the body they performed a service, as a way to curb…

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

…with the patient. That means the payer will ask for the reimbursement back for what they paid the practice for this service. Avoid this error: Never submit a claim if…

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

…$44, while 71045 will net you another $26, totaling $77 for the two codes together. Even if the payer takes 50 percent off of 71045 for the multiple procedure reduction,…

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

…CMS also found illegible documentation and missing documentation. This is a good reminder to ensure that all documentation is clear, valid and legible, and that you submit everything the payer…

Learn More
Contract negotiations
How to Respond When Payers Say โ€˜Noโ€™ 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…

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

…some time, take a close look at your claims and ensure that you are following all the payer guidelines, submitting the right codes and confirming that patients qualify for these…

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

…and money later because you were unable to lay the proper foundation for ERISA appeals. If you ever do get into a dispute with a payer and you want to…

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

…accurately — and because CPT modifiers are often tied to actual dollars, some payers are scrutinizing them to ensure they aren’t being abused. Check out three ways payers are keeping…

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

…to know and understand your payer policies. Medicare local coverage decisions (LCDs) are the payers’ bible, so they should be yours as well. When payers get a claim (or an…

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

…do, looking up the average pay for that code from the payer, and determining what the patient’s portion of the bill will be based on their coverage and plan. This…

Learn More
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…

Learn More
Patient billing
When Can You Charge Patients After Insurance Denials?

…healthcare attorney to make sure. Are You In-Network With the Payer? If you’re an in-network provider with the patient’s insurer, then your practice has agreed to accept the fee schedule…

Learn More
Insurance appeals
Master the Insurance Appeal Timeline to Fight Payer Denials

…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 they’re in by the deadline….

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

…every time so you can avoid OIG scrutiny and potential chargebacks. 1. Create a Payer Cheat Sheet As most coders and billers are aware, every payer has different requirements when…

Learn More
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…

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

…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 denying claims that don’t include…

Learn More
Telehealth toolkit
How to Use the OIGโ€™s Telehealth Toolkit to Benefit Your Practice

…help you assess the Telehealth Toolkit and use it to your advantage. Check the Five Key Payer Analysis Areas As part of the toolkit, the OIG advises payers to review…

Learn More
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…

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

…include charges for coinsurance or for services they wanted that aren’t covered by the payer. Now that those services have been rendered, you can ask them to pay the balance…

Learn More
Insurance contract
How to Time and Schedule Your Insurance Contract Negotiations

…lose those patients. If, for instance, just three of your 1,000 patients are covered by that payer, you likely have the upper hand in negotiations, because the payer knows you…

Learn More
Modifier 25
Cigna Delays Plan Requiring Medical Records With Modifier 25

…notes to support the significant and separately identifiable E/M service you’re submitting. Cigna originally tried to roll out this policy a year ago, but after significant pushback, the payer said…

Learn More
Prior authorization
How Medicare Advantage Prior Authorization Will Change in 2024

…a prior authorization from the beneficiary’s MA plan, the payer must prove that it has good cause to later deny that procedure, item or service down the road. This is…

Learn More
telehealth
Which Telehealth Rules Will Go Away When the PHE Ends?

…clear whether these relaxed telehealth guidelines around mental health services will become permanent, it’s a good idea to keep an idea on your payer’s coverage determinations so you’re aware of…

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

…charge patients when they fail to present for an appointment. Keep in mind, however, that Medicare and many other payers include a catch in their no-show fee rule: You must…

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

…code must have modifier FS appended to it. This tells the payer that even though you’re reporting under the NPI of one particular provider, the actual visit was performed by…

Learn More
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…

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

…payers take back therapists’ pay, so it’s important to adhere to. 10. Using Templates with Predefined Check Boxes, Answers Some therapists use documentation templates that include predefined answers, with check…

Learn More
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…

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

…to negotiating with insurers, do your homework and find out what the payer’s priorities are. For example, suppose the payer has an incentive program to reward practices whose patients present…

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

…in hearing more about all-cash medical practices? Watch as healthcare attorney Amanda Waesch, Esq., leads you through the ins and outs of the payer rules around this topic. During her…

Learn More
QMB
5 Staff Training Tips to Help Sidestep QMB Billing Issues

…patient has both Medicare and Medicaid is to ask them, and then verify with the payers. This is not as easy as it sounds, since patients may not realize how…

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

…all times. 5. Payer Requirements Because the front desk team often requests copays, informs patients of deductibles, and works with insurers on preapprovals, it’s essential that your staffers understand payer…

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

…Payer Responses Although the OIG has noted its position on prompt pay discounting when it comes to patients under federal healthcare programs like Medicare and Medicaid, private payers may not…

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

…information. This note fails to address the patient’s chief complaint, an explanation of what was performed, or how long the doctor met with the patient. That means the payer will…

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

…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 paying providers their salaries even…

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

…about to change, depending on your payer. Discover when you can report two evaluation and management codes, and when you should consolidate both visits into one E/M code this year….

Learn More
Amending medical records
5 Tips to Remember for Compliant Documentation Amendments

…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 record can paint a clearer…

Learn More
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…

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

…the three providers, the payer was processing claims for 80 visits a day under the doctor’s NPI. The payer audited the practice and said that although the incident-to claims were…

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

…key points can help you understand what to do instead of using an ABN form for Medicare Advantage patients. Some Payers Have Specific Non-Coverage Rules In certain cases, MA payers…

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

…changes to the contract, either by you or by the payer. You must know how you (and the payer) can amend the contract if needed. For instance, suppose you decide…

Learn More
CPT code 99211
Check These Four Documentation Rules for Reporting 99211

…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 find improprieties, you could not…

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

…see from them. Charges broken down by provider, payer, code: A very helpful report that every practice should have on-hand is a breakdown of charges by provider, insurer, procedure code,…

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

…a message (via mail or email) to your payer contact saying you’re escalating your request to a supervisor level. You can send the email to your payer representative and cc…

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

…payer the risks that come from the patient’s condition. Using the diabetes example above, you can add additional codes to show the risks the patient faces from diabetes, such as…

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

…credentialing and contracting with insurers, so that person is key to helping your practice set fees, evaluate coverage criteria, and confirm claims submission processes. The practice manager is also involved…

Learn More
Healthcare audit
Key Strategies Help You Avoid a Medicaid Audit

…referral-based, you should look into it before auditors do. Perform Self-Audits to Evaluate Your Billing Patterns Medicaid payers use data mining to evaluate whether your practice’s billing patterns are out…

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

…move forward with the service, and protects your practice, so if the insurer denies it, you can bill the patient. If your form doesn’t fit Medicare’s rigid standards, the payer…

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

…patients estimates of what they’ll owe you. But one slightly less-publicized part of the rule involves creating a provider directory and validating it with every payer. And if you don’t…

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

…Case When you’re writing the payer, you must have a reason to support your assertion that their denial was inappropriate, and that could be based on payer directives, information from…

Learn More
No show policy
3 Items Your No Show Policy Must Includeโ€”And 2 to Leave out

…will be uniform across your patient base but won’t violate any payer rules. 2. Specify How Far in Advance Patients Must Cancel You should always make it clear to patients…

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

…managed care contracts, but sometimes your payers write contracts to benefit themselves, and they might slip terms into the contract that are easy to miss. A healthcare attorney can help…

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

…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 tightly tied to your revenue….

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

…and counseling. This type of a visit would meet 99211 requirements, but unfortunately, most payers will not reimburse it. However, as always, it depends on the payer, so don’t write…

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

…add new providers, and stay on top of the 90-day revalidation requirement to avoid getting dropped from a payer contract. What Is CAQH ProView Practice Manager? This free feature of…

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

…by payors issuing your practice claim denials, check out Healthcare Training Leader’s online training session, Persuade Payers to Pay Up with Successful Appeals Process. This 60-minute training session gives you…

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

…or contracting with a vendor that the OIG has designated as excluded from billing Medicare and Medicaid. Without it your practice can be hit with significant enforcement actions, or worst,…

Learn More
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…

Learn More
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…

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

…no field_60a298f4110c3 field_5d261ad51e5f8 Payer contract negotiations Payer contract negotiations Ace Payer Contract Negotiations with Administrative Burden Calculation Payer contract negotiations are stressful. Get more money from your payers by calculating…

Learn More
Medicare Revalidation
Medicare PECOS Enrollment Revalidations Resume Oct. 2021

…processes, check out Healthcare Training Leader’s Enrollment Training site. Just a few of the enrollment topics you’ll receive expert advice on include: Payer Delegation, Commercial Payers, Medicare PECOS (CMS Forms…

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

…down with your patients to explain your no-show policy can improve compliance. Also, be sure to make it clear that payers don’t typically reimburse fees associated with late cancellations, late…

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

…of practice-based patient termination letters from a variety of sources that may help you craft your own version: Highmark – example from payer American Academy of Family Physicians – example…

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

…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 your practice clearly understands what,…

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

…payer contract will likely require you to jump through a number of hoops before you can dismiss their patients (this is true for private payers, too). Be sure you know…

Learn More
Medicaid audit
Prevent Medicaid Audit Triggers, Fast and Easy

…will this person keep you from committing costly billing errors resulting in Medicaid audits and takebacks, but they’ll likely be familiar with the rules of other payers like Medicaid and…

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

…calling a payer with a question about a patient’s benefits, and you get their voice mail. Here are two examples of the voicemail you might leave. One detailed and straightforward…

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

…payer contracts will spell this out, it’s important that you double check. Failure to comply with payer rules can result in you being in breach of contract and dropped from…

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

…20% that Medicare doesn’t cover, you must go directly to the patient versus being able to bill their secondary insurance. In many instances, the patient’s secondary payer will reimburse them…

Learn More
pecos-medicare-enrollment
Use PECOS to Speed Up Medicare Enrollment Efficiency

…designated to manage your providers’ accounts in CMS systems. That in itself can be a little tricky as you will need to comply with Medicare enrollment regulations or risk payer…

Learn More
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…

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

…sharing of provider information. So instead of having to send the same paperwork over and over again to each payer you want to enroll with, you do it once. The…

Learn More
Practice's Worth
Prove Your Practiceโ€™s Worth to Payor and Reap the Financial Reward

…you’ve been dropped. For more practical, step-by-step strategies sign up for the on-demand online training series presented by contracting and credentialing experts, Olga Khabinskay, MBA, COO and Doral Jacobsen, MBA,…

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

…money by the payer). Co-surgeons each receive 62.5% of the fee schedule amount, for a total of 125%. A physician assisting receives only 16% of the fee (while the lead…

Learn More
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…

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

…and 2021. Medicaid payments: Medicaid reimbursement rates vary by state and whether the patient has managed care or fee-for-service coverage. Commercial insurance reimbursement: Private payer rates will vary. New releases:…

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

…Legal Penalties for Requiring Employee Vaccinations Renegotiate Payer Contracts to Boost Payup by 12% New Sept. COVID-19 Employment Rules: Head Off Violation Penalties . . . 1633615568:44988 57370 no no…

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

…Source: If the request is from a payer, you first should check your contract. You may be contractually limited based on your negotiated rate with the health plan. For instance,…

Learn More
HHS Money FAQ
5 FAQS Snag More CARES Act Provider Relief Money

…,” she’ll walk you through the EXACT steps of the provider relief funding application process and reporting requirements. More Online Training Resources . Renegotiate Payer Contracts to Boost Payup by…

Learn More
Renegotiating Payer Contracts
6 Winning Contract Renegotiation Tactics

…careful, you could be distracted by payers’ sneaky tactics: Renegotiating Payer Contracts. Payers often shift money around, so it seems like you’re getting a rate boost in one area, when…

Learn More
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…

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

…longer terminal, but want to continue with hospice. Check Patient Coverage for Secondary Payer If a patient has secondary coverage, that payer may pay for services that Medicare doesn’t cover….

Learn More
OIG Telehealth Audit
Learn How to Avoid Telehealth Audit Traps

…clinician provides a service “incident-to” a supervising provider, the supervising provider should sign the record. Follow Payer Rules It’s a familiar refrain, but all payers are not the same. Check…

Learn More
Terminate patient
Terminate a Patient Without Getting Sued

…referring patients. Insurance Change: If you are leaving a particular payer or insurance network, it might make more sense for your patient to find an in-network provider. Consider extending your…

Learn More
Head Off $2 Million Medical Billing Fraud and Abuse Violation

…more appropriate. Do not use modifier 59 to prevent services from being bundled or bypass payer edits. And remember: When using modifier 59, always append it to the service that…

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

…can protect your employees from contracting COVID-19 such as installing sneeze guards at the front desk and check out area. Covid-19 Resources For Your Practice . SBA PPP Rule Update:…

Learn More
Medicare AWV COVID
Rebuild Wellness Visit Revenue During COVID-19

…to slow the spread of COVID-19, notes the CDC. Offering telemedicine visits allows patients to keep their routine visits without exposing themselves or your practice and staff. Relaxed payer policies…

Learn More
PECOS Surrogacy
PECOS: Simple Solution Expedites Enrollment Process

…Requirements Improve Provider Credentialing/Enrollment Results, Monitoring Tool Key Master Payer Delegation to Speed Enrollment and Payments . . . 1639686902:55179 57370 185647 no yes 80113 field_5d261ad51e5f8 PECOS surrogacy PECOS surrogacy…

Learn More
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…

Learn More
5 Steps Prevent Overcharging COVID-19 Testing

…and some private payers mandate using HCPCS level II supply codes over CPT codes. But there are third party payers that require you report CPT codes to receive reimbursement for…

Learn More
New CMS Telehealth Rule: Speed Cashflow, Update Billing

…Kim Garner Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, on April 8th, and will be covering private payer telemedicine reimbursement Take Advantage of Our Best-selling Telehealth Resources CMS April Telehealth…

Learn More
Cheat Sheet Masters Emergency Telemedicine Policies Coverage

…you call, if you don’t get similar allowances, be sure to reference what these Alabama major payers are doing – and see if your payer allows the same. Originating Site…

Learn More
Prevent HIPAA Penalties: 5 Emergency Disclosure Rules to Follow Now

…public health authority, to a foreign government agency that is acting in collaboration with the public health authority. At-risk Persons: To persons at risk of contracting or spreading a disease…

Learn More
psychotherapy CPT
2 Proven Strategies Boost Psychotherapy CPT Code Pay

…insurer is. Some payers require prior authorizations for 90837. If you don’t have one, the claim will be rejected and you’re patient won’t be happy. If a payer requires a…

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

…services) or with private payer patients, but you may choose to do so as a courtesy. When you know services are not covered by Medicare, even though you aren’t required…

Learn More
Boost Your Online Reputation to Drive Referrals and Bring New Patients

…Online Reviews of Your Practice to Win More Patients $277.00 – $917.00 Price range: $277.00 through $917.00 Select options Head Off HIPAA Front Desk Nightmares $247.00 Select options Negotiate Payer…

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

…payer contacts and federal laws. Your payer contracts require you to collect patient cost-sharing amounts. Not doing so can violate your contracts and potentially federal fraud and abuse laws. Further,…

Learn More
Balance mistakes
Donโ€™t Let Everyday Billing Mistakes Land You in Legal Hot Water

…extend professional courtesy in the form of waiving copays, do not also submit a claim to the payer. Waiving a copay while receiving reimbursement from the payer could be interpreted…

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

…pay the lesser of your billed or contracted charge. So if you’re billing patients at a lower rate than you’ve contracted with your payer, the payer can choose to pay…

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

…Know Payer Policy and Track It Policies are specific to each payer, and most payers post coverage related policies online. You should know and keep track of these policies, track…

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

…ABN for services that are not part of the Medicare program (statutorily excluded services) or with private payer patients, but you may choose to do so as a courtesy. When…

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

…payer — selection process in the winter/spring of 2020 and conduct onboarding for selected organizations between July and December 2020. 2. The Primary Care First model consists of two tracks…

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

…1699559904:62229 57370 no yes field_5d261ad51e5f8 third-party payer appeals third-party payer appeals Third-Party Payer Appeals — How to Fight Back to Boost Reimbursements Third-party payer appeals are worth the effort but…

Learn More
OIG Watch List: Protect Payments from Urine Drug Test Audits

…to two new Medicare Part B watch items. In 2020, tCMS and private payers will begin review of: urine drug testing services payments for speech-language pathology Good news: You’ve still…

Learn More
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…

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

…best way to protect your payments. For these answers, read on. Will X Modifiers Instead of Modifier 59 Avoid Anthem Scrutiny? While X modifiers were introduced in 2015, most payers…

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

…is triggered. Know your payer contracts. They may have restrictions, limitations on when you can terminate patients and required notification periods Follow up via mail. Send a written notification to…

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

…face staff and provider 3) meets the payer’s guidelines for code usage such as Medicare’s incident-to requirements or a private payer’s variations. These guidelines require the physician be present in…

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

…challenges. You’re concerned about whether it’s worthwhile to contract with a given payer, how to handle payers that don’t use CAQH, and knowing if your contracted rates are competitive. Plus,…

Learn More
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…

Learn More
provider credentialing
New Provider Credentialing: Your Top 10 Questions โ€” Answered!

…payers (Medicare, Medicaid, and private payers) or seek admitting privileges at a hospital. Provider credentialing goes a step further. Credentialing is the process of obtaining, verifying, and assessing a provider’s…

Learn More
Watch Out for These 11 Devious Payer Contracting Negotiation Tricks

…yes payer contracting payer contracting Learn Our 11 Tricks on How to Negotiate a Payer Contract Read our blog to understand valuable payer contracting negotiation tips in order to combat…

Learn More
abn form
Medicareโ€™s ABN Form: Top 10 Mistakes Youโ€™re Making (and How to Fix Them)

…payer policy. Use it when: You’ve issued a mandatory ABN and the patient has chosen option 1. GX: Notice of liability issued, voluntary under payer policy. Use it when: You’ve…

Learn More
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…

Learn More
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…

Learn More
TRICARE Transition
TRICARE Transition Clarification

…about each process below. Contracting: Complete a new provider contract with Health Net Federal Services. EDI: No action required. Per PGBA, Payer ID and EDI agreements will remain in place…

Learn More
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…

Learn More
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…

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

…of the program. Under the Advanced Alternative Payment Model (APMs): Other Payer Advanced APMs — CMS is looking for ideas regarding the overall design of Other Payer Advanced APMs by…

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

…was code in the correct family and that was good enough. The problem is, that during the past year, Medicare payers didn’t give you much feedback when your coding wasn’t…

Learn More
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…

Learn More
page
Free eGuide: Achieve a 99% Clean Claim Rate & Maximize Efficiency

…your claim payments but also to elevate your negotiation game to new heights. As a dedicated practice manager, you know the challenges of navigating the complex terrain of payer contracts…

Learn More
Get up to 11 AAPCยฉ-approved CEUs!

…telemedicine services, the majority of states now have laws requiring private payers to also pay for them. REGISTER TODAY CPT Code 99211: Get $15 Per Patient on Nonphysician Work On-Demand…

Learn More
medical-qa
When Should a Medical Practice Appeal a Denied Claim?

…May Be Appropriate Appeals are generally appropriate when the practice believes the payer’s decision was incorrect. Examples include: Medical Necessity Denials: The payer determines the service was not medically necessary,…

Learn More
How Often Should Providers and Coders Receive Coding Education?

…make is: “We’ve always done it this way.” Healthcare changes too quickly. Every year brings: CPT® changes ICD-10-CM updates New payer policies Documentation expectations Audit focus areas Even experienced providers…

Learn More
Which Insurance Payers Should Practices Enroll With First?

…based on the population being served rather than assumptions about which payers are important. Review Your Payer Mix One of the best places to start is with your payer mix…

Learn More
What Accounts Receivable Metrics Should Every Practice Manager Monitor?

…A/R often indicate problems Consistent improvement suggests a healthy revenue cycle Increasing Days in A/R may signal: Billing delays Claim denials Follow-up deficiencies Payer payment issues This metric often serves…

Learn More
How Long Should It Take to Get Paid by Insurance?

…Monitor payer processing times. Review aging reports weekly. Track accounts receivable by payer. Follow up on outstanding claims. Analyze denial trends monthly. Train billing staff on payer updates. Audit documentation…

Learn More
What Happens After a Practice Receives an Audit Request?

…a payer, Medicare contractor, or government agency, what should we expect, and what steps should we take immediately to protect the practice?” field_tl_medical_question Few things create more anxiety in a…

Learn More
How Do ICD-10 Diagnosis Codes Affect Reimbursement?

…hours discussing procedures while giving very little attention to diagnosis coding. Remember: The procedure tells the payer what you did. The diagnosis tells the payer why you did it. Without…

Learn More
What Happens If a Provider Sees Patients Before Enrollment Is Complete?

…(formerly CAQH), Medicare enrollment, payer contracting, revenue cycle management, and practice operations. When your team understands enrollment requirements and payer participation rules, you can reduce delays, improve planning, and help…

Learn More
Where Do Revenue Leaks Usually Occur in a Medical Practice?

…recognize that protecting revenue is everyone’s responsibility. Real Practice Example A growing cardiology practice believed declining reimbursement was primarily caused by payer fee schedule changes. After reviewing its revenue cycle,…

Learn More
What Is the Difference Between a Rejected Claim and a Denied Claim?

…The payer’s electronic claim-editing system Practice management software Front-end payer edits A clearinghouse may review claims for common errors before sending them to the insurance company. When it identifies a…

Learn More
Why Do Small Compliance Problems Turn Into Big Compliance Problems?

…was discovered. A mistake is treating compliance issues as one-time events. A denial is not just a denial. A payer request is not just a payer request. An employee complaint…

Learn More
What Is Medical Coding and Why Does It Matter?

…provided—and your documentation backs it up—you give the payer the information it needs to process the claim correctly. When the coding or documentation falls short, reimbursement, compliance, and even patient…

Learn More
What Information Should You Gather Before Starting Provider Enrollment?

…establish communication channels. Review Existing Payer Contracts One of the most valuable resources during enrollment is existing payer agreements. Reviewing payer contracts can help you identify: Effective dates Participating status…

Learn More
How Often Should Medical Practices Submit Insurance Claims?

…how does claim submission timing affect cash flow?” field_tl_medical_question Every day a completed claim sits in a queue is another day before payment can begin moving through the payer’s system….

Learn More
What Is the Difference Between Medical Coding and Medical Billing?

…them to payers, monitor claim status, post payments, resolve denials, and collect patient balances. Coding determines what services are reported, while billing focuses on how those services are reimbursed. Coding…

Learn More
What Is the Difference Between Provider Enrollment, Credentialing, and Privileging?

…information Entering data into payer portals Uploading supporting documents Completing Medicare and payer registration requirements Responding to follow-up requests Many organizations now require enrollment through online portals rather than traditional…

Learn More
What Employment Law Mistakes Put Physician Practices at Risk?

…spend significant time worrying about payer audits, HIPAA compliance, and reimbursement challenges. However, one employee complaint can quickly become a costly legal issue. Most employment lawsuits don’t start because an…

Learn More
Why Are My Medical Claims Being Denied?

…Invalid subscriber information Wrong payer Many of these errors originate at patient registration. Filing Deadlines Were Missed Every payer has claim filing limits. Some allow 90 days. Others allow 180…

Learn More
How Often Should Physician Practices Review the OIG Work Plan?

…and E/M documentation directly affected their providers. The practice conducted focused chart reviews and provider education sessions based on those topics. Months later, when a payer review occurred involving one…

Learn More
Why Are My Level 4 and Level 5 Office Visits Being Downcoded?

…the payer believes the documentation does not support the level of service billed. This can happen because of incomplete medical decision making, insufficient documentation, payer review policies, automated claim review…

Learn More