99211 Q&A: Get Paid More for Your Nonphysician Staff Services

You can get paid for the additional services provided by your medical assistants and registered nurses provide. The amount depends on the number of non-physician staff you employ. For a small practice, this can equal as much as $20K more per year. To access this additional reimbursement, you must correctly utilize CPT code 99211 for […]
incident to billing rules

NPP Initial Office Visit: Avoid Billing Audits & Penalties

Correctly billing your non-physician practitioner (NPP) services as incident to under your physician’s National Provider Identifier (NPI) number has various benefits to your practice. The most significant benefit of complying with incident to billing rules is that the services can be paid at 100% of the physician fee schedule (15% higher than billing directly under […]
Insurance preauthorization

Speed up Insurance Preauthorization with CPT Code Tracker

The insurance preauthorization process is tedious and frustrating, but it’s a requirement if you want to get paid for services you provide. One of the main issues with the process is that each payor has its own requirements for getting procedures preauthorized. Further complicating the system is the fact that what one payor requires preauthorization […]

No Surprise Act: Avoid Billing Violations for Out-of-Network Plans

Legally, you are not required to bill a patient’s secondary insurance plan if you are out of network. Instead, you can choose to bill the patient directly, but doing so can put you at odds with the No Surprises Act implemented Jan. 1st of this year. This new regulation requires that you follow very clear […]
RTM codes

Boost Payup, Improve Patient Care with 2022 RTM Codes

You can now get paid more for using digital health technology with your patients. As of January 1st, new codes for Remote Therapeutic Monitoring (RTM) allow you to get reimbursed for monitoring non-physiologic data. These codes opened up more patient care options, allowing your practice to use newer technology and still get reimbursed for it. […]
No-win appeals

Save Time & Frustration, Identify Top 3 No-Win Appeal Cases

You’ve just opened the mail to discover several more denials by insurance payors. With reasons ranging from non-covered services to lack of proper documentation, battling back the seemingly never-ending tide of denials can feel like a full-time job. No-win appeals. Not only do stacks of denials seriously eat into the time you could be spending […]
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 […]