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 […]
Outsourced medical billing

Why This Part B MAC Cautions Practices About Outsourcing Billing

Working with an outsourced medical billing company can improve the workflow in your practice, allow you to take some of the work off of your team members and help bring in reimbursement faster. And according to one Medicare Administrative Contractor (MAC), it can also put you at risk of reputational harm and HIPAA violations. Background: […]

Collect More E/M Pay in 2024 With New Add-on Code G2211

It’s not often that CMS presents coders with a way to collect more for E/​M visits, but in 2024, you’re about to benefit from a relatively new add-on code that allows you to do just that with the implementation of G2211 effective January 1. Discover the facts you must know if you want to collect […]
Dental insurance

Dental Insurance vs. Medical Insurance: Discover Which to Bill

When you see patients for oral health care, it can sometimes be challenging to determine whether to bill their visit under their dental insurance or their medical plan. But understanding the nuances of each type of coverage can help every practice make the right choice. Consider these best practices when differentiating if you should bill […]
Radiology coding

3 Radiology Coding Best Practices to Keep Imaging Pay Flowing

Providers perform diagnostic radiology services not only to evaluate a patient’s condition, but also to follow up on progress or determine whether a treatment is working. Coding these services sometimes seems straightforward, but it’s easy — and dangerous — to get complacent about radiology coding. Check out three tips that can help you ensure that […]