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Modifier 25

3 Modifier 25 Best Practices to Keep Your E/M Pay Flowing

Every minor procedure your providers perform includes an inherent evaluation and management (E/​M) portion factored into the reimbursement for it. But when you go beyond that cursory E/​M work, you should be able to collect for the extra time your provider spends — and that’s where modifier 25 comes in. Although modifier 25 represents a […]
Medicare claims

7.3% Medicare Error Rate Puts Documentation Issues in Spotlight

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

6 HIPAA-Compliant Ways to Respond to Online Patient Reviews

Your medical practices is like any other business, in that it has an online presence — which means that sometimes, online reviews are posted, and they aren’t always positive. However, responding to online reviews, even if you feel you’re simply defending your practice, can land you in hot water if your response accidentally violates patient […]

8 Times an ABN Is Mandatory (and 8 Times It Isn’t)

One of the most challenging aspects of handling an advance beneficiary notice (ABN form) is identifying when you MUST present it to your patient and when it’s considered “voluntary.” The line between these two seemingly similar situations could be what separates a paid claim from a denial. Get the facts on when an ABN form […]
Contract negotiations

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

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

4 Major 2024 Changes Rural Health Clinics Must Prep for Now

Rural health clinic staff members have to navigate reams of regulations and bureaucratic red tape to collect for general care management services, but the good news is that collecting for these services is about to get a lot easier. Check out four changes for 2024 that will help every rural health clinic collect more revenue […]
Service animals

Untangling the Rules Around Service Animals at Your Practice

When patients or employees want to bring service animals or emotional support animals into your practice, you must tread very carefully. If you make a misstep, you could face lawsuits, regulatory agency fines and reputational damage if you violate the Americans With Disabilities Act. On the other hand, if your emotional support animal policy is […]
Telehealth services

CMS Updates Telehealth Rules, Approves Using E/M Code G2211

If your practice has been eagerly awaiting word from CMS about how Medicare payments would be calculated in 2024, the wait is over. The agency released its 2024 Physician Fee Schedule Final Rule on November 2, and the provisions include a 3.4% lower conversion factor of $32.7375, updates to the telehealth rules, approval of using […]
OIG work plan

HHS Adds 3 Key Issues to Latest OIG Work Plan Document

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

How to Gather ERISA Documents That Help You Slash Denials

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