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Medicare Advantage Overpayments

Keep 60% Pay by Acting on Medicare Advantage Overpayments by Feb

If your physicians participate in Medicare Advantage Plans, keep a sharp eye on the mail. The final Medicare Advantage Overpayments letter is being mailed to practices the first week of January, and it contains a time-sensitive CMS settlement offer that you must act on this Winter or risk significant financial losses. Medicare Advantage Overpayments Letters […]
Published Date: January 3, 2020
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Does Medicare Fee Schedule Include E/M Changes for 2020?

QUESTION: I’m pretty nervous about the significant changes to the Evaluation and Management (E/​M) codes being made soon. The 2020 CMS Physician Fee Schedule goes into effect January 1, 2020, Does it contain the changes? ANSWER: The 2020 Medicare Physician Fee Schedule Final Rule confirms that the E/​M code changes completely take effect in 2021. […]
Published Date: December 31, 2019
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Credentialing Hospital Privileging

Speed Up Doctor’s Hospital Privileging

QUESTION: Our providers have privileges at two separate hospitals. Every couple of years, they make us jump through a variety of hoops to keep our providers’ hospital privileges active. This year, one of the hospitals is asking us to send provider references. Who should we ask? Anonymous, Alpharetta, GA ANSWER: Hospitals typically ask for three […]
Published Date: December 26, 2019
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CPT coding 99201 99215 Office Visits

Don’t Lose $64 Per CPT 99201 – 99215 Office Visits for New and Established Patients

Determining whether a patient is new or established shouldn’t be complicated — but coding CPT 99201-99215 office visits is oftentimes not so clear. Miscoding these E/​M visits, however, can cost you thousands of dollars each year in lost revenue. In fact, selecting an established patient when you should have billed a new patient office visit […]
Published Date: December 23, 2019
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Coding CPT Injection Infusion

4 Must-Know Injection and Infusion Tips to Boost Pay Up

Correctly coding for injections and infusions can often feel like a shot in the dark. From assigning codes for multiple drugs to add-on codes to accurately documenting stop and start times, even the most experienced coders feel the pinch of these complex coding guidelines. But code claims incorrectly, and you could be costing your practice […]
Published Date: December 19, 2019
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OIG Medicare Payment

OIG Report Raises Concerns about Medicare Advantage Payments

You should expect to see Medicare providing more oversight and audits on chart reviews, specifically ones that result in additional patient diagnoses and payment. A U.S. Department of Health and Human Services Office of Inspector General (OIG) December 2019 report has raised concerns over billions of dollars in Medicare Advantage payments generated from chart reviews. […]
Published Date: December 18, 2019
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Balance mistakes

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

Billing mistakes have more serious implications than you just seeing a decrease in your reimbursement.  Some of the most common billing errors can get your practice audited, and result in you paying massive violation penalties. Unfortunately, accurately billing for outpatient services is so much more complicated than just submitting a claim or sending an invoice. […]
Published Date: December 17, 2019
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Payer Negotiations: 5 Fee Schedule Prep Steps to Lock in Higher Rates

Preparation is key to any project or endeavor, and payer contract negotiations are no different. If you don’t have your ducks in a row including your fee schedule pricing demands and arguments, you could be shut down before you’re even out of the gate. The fee schedule portion of your payer contract outlines the rate […]
Published Date: December 13, 2019
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Practice QA: Fend Off Costly Front Desk HIPAA Fax Fines with 6 Actions

QUESTION: I’m trying to prevent my front desk from making HIPAA mistakes when we send and receive faxes that contain protected health information (PHI). What should and shouldn’t you send electronically? Do we need any kind of release on file? Rochester, NY ANSWER: The first key in making sure that front desk HIPAA fax activity […]
Published Date: December 12, 2019
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Prior Authorization Billing

8 Tips to Speed Up Your Prior Authorizations and Reimbursement

Most patients are waiting for prior authorizations and that wait is negatively impacting their care. That’s why it’s critical that you get patient prior authorizations approved as quickly as possible — so you can get paid and your patients can get the treatment they need. The good news is that you can reduce your prior […]
Published Date: December 10, 2019
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