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Billing

Billing

Balance billing

Save This Checklist to Stay in Line With Balance Billing Rules

When a patient faces an emergency medical issue, they may end up getting treated at an out-of-network facility. In these situations, patients previously faced steep costs because their insurance plans didn’t cover out-of-network fees, and they’d get a balance billing invoice for the difference between the billed charge and the amount the insurance company paid. […]
erisa

How ERISA Can Help Back Up Some Timely Filing Denials

It happens from time to time: Your provider agreement dictates one time period as the timely filing deadline, and the patient’s policy notes a different time period. If this discrepancy is confusing, that may be because insurers like it that way. However, if you have ERISA on your side, you can sort through this issue […]
Place of service codes

Tips for Using Place of Service Codes—Including the Newest One

It’s not every day that CMS releases new place of service codes, but on August 9th, the agency issued one that every healthcare provider should know. Check out details of the new POS code, along with tips on using place of service codes so you can get paid for your services. Welcome POS 66 Last […]
Incident to

5 Incident To Best Practices That Allow You to Collect More

Want to collect an extra 15% for your providers’ services? Who wouldn’t? If the provider in question is a nonphysician practitioner (NPP), you may be able to do so if you master incident to billing. Check out five tips that will help you bring in maximum pay for your NPP’s incident to services. 1. Make […]
Revenue cycle management

How Your Practice Can Improve Revenue Cycle Management

Only 25% of U.S. medical practices think they’re getting every dollar they deserve, according to a recent survey. And just as many said they think their staff members spend way too much time on revenue cycle management responsibilities. Wondering what may be behind the inability of practices to collect the money they’ve earned? Check out […]
Insurance appeal letter

Master the Perfect Insurance Appeal Letter in 4 Easy Steps

When you get a denial from your payer, your first step may be to immediately start putting together an insurance appeal letter so you can capture the pay for services you’ve provided. That’s an excellent habit, as long as you know what to include in your letter. Check out four steps that can help you […]
Prior Authorization

Prior Authorization Errors Skyrocket: 3 Tips Help You Avoid Issues

Insurers are denying prior authorization requests at an alarming rate, and that means your patients can’t get the care they need — and you don’t get paid for your services. A new report indicates that inpatient prior authorization denials are up 26%, while prior authorizations and precertification’s for outpatients rose 16% between 2021 and 2023. […]
Diabetes screening

Medicare Announces NEW Coverage for Diabetes Screening

It isn’t often that CMS expands its screening coverage to pay for more tests, but that time arrived earlier this month, when the agency announced upgraded Medicare pay for an additional diabetes screening test. The agency also slightly changed the diabetes screening guidelines to make them more favorable and easier to follow. Find out what […]
Insurance appeal

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

Medical insurance claim denials can be devastating to deal with. Not only do they take time and energy — they prevent your practice from collecting revenue for services you’ve already performed. The most common way to tackle a denial is to file an insurance appeal, which can help you reverse those denials. To ensure that […]
Medicare demand

3 Ways You Might Respond to a Medicare Demand Letter

Whether you’ve coded a claim incorrectly, failed to justify medical necessity or made another error, you’re likely to receive a Medicare demand letter asking for money back in certain cases. Any time your MAC pays you $25 or more in excess of what they should have, you’re subject to the recovery and recoupment process, which […]