The No Surprises Act is about to dramatically change how your practice gets paid for out-of-network services.   The Department of Health and Human Services (HHS) is not kidding around when it comes to the enforcement of the No Surprises Act. If you fail to comply, you can be hit with fines of up to […]

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

You are not alone when it comes to the challenge of correctly implementing the massive changes implemented this year related to the 2021 Evaluation and Management (E/​M) guidelines. It’s no surprise that the American Medical Association’s (AMA) CPT Editorial Panel has received numerous questions and requests for clarification on these new rules. As a result, […]

Interchanging the terms credentialing and enrollment is a surefire way for your provider reimbursement to take a serious hit. The problem is that there is definitely overlap between them. Ultimately, however, having a solid  understanding of each process is the only way to more efficiently and accurately manager your payor approval process and to get your […]

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

With the expiration of the Families First Coronavirus Act (FFCRA) and no new government guidance to replace it, knowing how to handle paid time off (PTO) requests related to COVID-19 is a challenge. You certainly want to ensure that your staff are okay, but you also have a business to run that requires you to […]

Correctly reporting how you used the CARES Act Provider Relief funds you received from the Department of Health and Human Services (HHS) is imperative. The problem is figuring out how. Attesting to the funds that you received was the first step. Your practice had 90 days from the date that you received the money to […]

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

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

How and when you grant access to your patient medical records is about to change. Effective April 5th, 2021, new federal guidelines require you to more readily grant access to your patients’ health information, or else. Information blocking exceptions. The regulation driving this change is the new 21st Century CURES Act (also referred to as […]