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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 […]
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 […]
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 […]
Patient payment estimator

Price Transparency: How to Give Accurate Estimates to Patients

If you’re looking for a new way to bring in cash, check out this statistic: About 52% of patients would pay $700 more by credit card when visiting a physician if they’d gotten an estimate at the point of care. That stat from a McKinsey quarterly survey of retail health care consumers demonstrates just how […]
Incident to billing

3 Examples Help Strengthen Your Incident To Billing Skills

When a nonphysician practitioner (NPP) sees a Medicare patient at your practice, you can typically plan to collect a reduced rate compared to what a physician would receive for the same service. But one way you can avoid accepting 15% less pay for the same service is by utilizing incident to billing — if you […]
Patient billing

When Can You Charge Patients After Insurance Denials?

It’s a common occurrence at medical practices: You submit a claim to the insurer and in return, you get a denial. You don’t want to absorb the cost of the service you’ve already provided, so your next step is to determine whether you can bill the patient directly. While patient billing may be a complex […]
Insurance appeals

Master the Insurance Appeal Timeline to Fight Payer Denials

Working in healthcare is stressful enough without having to track your appeals on the calendar — but staying on time and meeting appeal deadlines will be essential if you want 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 […]
JZ modifier

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

When CMS debuted the JZ modifier last November, the agency gave practices until July 1 to start using it, allowing for a brief period so billers could get to know 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 […]
Time-based coding

9 Things You Can Count Toward E/M Time (and 4 You Can’t)

When the office-based E/​M coding guidelines changed in 2021, coders faced a huge learning curve. It involved transitioning from selecting the right code based on history, exam and medical decision making (MDM) to choosing the most appropriate code based on either time spent or MDM only. And while coders have weathered the change by now, […]
Split/shared billing rules

3 Ways to Prepare for the Split/Shared Changes Coming Soon

As many practices are aware, the split/​shared billing rules changed earlier this year, and are in for an even bigger overhaul starting January 1st. If your practice is trying to get ahead of the curve, now is a great time to get a handle on what will change in 2024 and what you’ll need to […]