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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 […]
2024 ICD-10-CM

Ace the April 2024 ICD-10-CM Changes Before Next Week

Every medical coder and biller knows that the best way to justify medical necessity in your claims system is to use the right diagnosis codes. And while the 2024 ICD-10-CM codes were released last fall, CMS recently issued an April update that could turn your coding processes upside-down. Check out several April 2024 ICD-10-CM changes […]
Telehealth billing

Avoid These 4 Telehealth Billing Errors to Keep Pay Flowing

Seeing patients virtually has become such a common practices that many healthcare providers and patients prefer it over in-person visits. The best way to keep your reimbursement flowing for these encounters is to ensure that your telehealth billing practices are compliant. Check out four common telehealth billing mistakes that could derail your pay for these […]
Prior authorization

5 Ways to Reduce the Prior Authorization Burden at Your Practice

Every practice knows that handling a prior authorization case load can be time-consuming and burdensome. Not only do payers require you to spend endless time filling out forms and even sitting on hold when you call, but they often end in erroneous denials. In fact, one OIG report found that an alarming 13% of Medicare […]
Write off

3 Patient Charges You Can’t Write Off (and Some You Can)

Routinely writing off out-of-network or government program copayments or deductibles without meeting individual financial hardship exceptions will most certainly land your practice in hot water with the OIG and insurers. That is, unless you know exactly how to comply with the fraud, waste and abuse laws about which charges you can write off. Check these three charges […]

Don’t Look for G2211 Pay With Your E/Ms Until February

G2211 is one of the most eagerly-awaited codes of 2024, allowing your practice to collect an extra $16 from Medicare when you perform an E/​M service for a patient whose ongoing care your doctor is providing. Practices that are counting on that extra pay to come through, however, should plan to wait just a bit […]