No surprise billing act

No Surprise Billing Act: Ace Good Faith Estimates for Self-Pay

The No Surprise Billing Act threw a wrench into how you bill self-pay patients and insured patients who don’t want their plan billed for services. The law, which went into effect January 1, laid out clear – if complicated – guidelines for just what can be considered a Good Faith Estimate (GFE) for anticipated services. […]
Telehealth mental health

Tele-Mental Health: Medicare Extends Reimbursement to 2023

CMS has good news for you and your patients regarding the telehealth mental health care you’ve provided since the pandemic: Medicare will continue to reimburse for these services for at least two more years. Originally, the addition of reimbursement for telehealth mental health services was temporary due to COVID, and expected to expire at the […]
Medicare physician fee schedule

Head Off 2022 Medicare Physician Fee Schedule Change Errors

The November 3rd release of CMS’ 2022 Medicare Physician Fee Schedule (PFS) is chock full of changes that have the potential to significantly modify how you bill and receive payment next year. Unfortunately, one of the most disappointing changes is that Congress has decided not to renew the additional 3.75% conversion factor rate added during […]
self-pay patient

Can You Bill a Self-Pay Patient Less than Medicare?

The Answer: Yes, you can charge your self-pay patients less, as long as you don’t break federal Medicare laws when doing it. Knowing how and when to apply a discount and write-off for a self-pay patient is essential to your practice. It can reduce your risk of violating Medicare and other federal laws – including the […]
No Surprises Act

How the No Surprises Act Affects Out-of-Network Collections

The No Surprises Act is about to dramatically change how your practice gets paid for out-of-network services.   The Department of Health and Human Services (HHS) is not kidding around when it comes to the enforcement of the No Surprises Act. If you fail to comply, you can be hit with fines of up to […]
COVID Vaccine Admininstration Coding

Get the Correct COVID-19 Vaccine Administration Code and Pay

You MUST use a totally different system to get paid and code for COVID-19 vaccine administration; unlike other vaccines that use generic administration CPT codes, coronavirus vaccine reporting requires unique codes. Get up to speed now on the available vaccines and how to report them correctly from your very first claim without over billing. There […]
coordination benefits

Coordination of Benefits: Reduce Payment Delays with Six Simple Steps

QUESTION: We experienced an increase in Coordination of Benefits (COB) issues with Medicare last year. We finally found out there was a “glitch” in their system. The previous accident claim information was populating the primary insurance field. It took us quite a while to recover from this. What can we do to avoid issues like […]
2021 Medicare Physician Fee Schedule Telehealth

2021 CMS Fee Schedule Proposes 5 Telehealth Changes

Your telephone, telehealth exam, and virtual check-in pay could come to a grinding halt unless you’re up to date on the latest potentially upcoming changes to the 2021 Medicare Physician Fee Schedule. Auditors will be checking to see if you tightened your regulations for coding, compliance and more. Prep your practice now on the top […]
Medicare ABN Mandatory

Is an ABN Mandatory or Voluntary? Here are 4 Clues to Decide

The Medicare Advance Beneficiary Notice (ABN) form is only one page long, but accurately completing the process can be as tedious as waiting for the repair man to show up. And it’s really critical that you take the time to get each step right, or you’ll be faced with increased write-offs and could even land […]
Head Off $2 Million Medical Billing Fines

Head Off $2 Million Medical Billing Fraud and Abuse Violation

You could be fined up to $11,000 for each false item or service you submit to Medicare. That means, your total penalty amount could be HUGE – reaching into the millions as it did for one physician practice. Halt massive penalties from crippling your practice by fixing these common medical billing fraud and abuse errors. […]