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G0316: CMS Corrects Time Threshold Errors in 2023 Final Rule

Everybody makes mistakes, but when it’s CMS creating the error, it can create ripple effects through your practice. Hopefully, the agency’s latest mistake provides your practice with a benefit rather than a headache. At issue is the time threshold that must be met to report code G0316, which represents prolonged inpatient/​observation care for Medicare patients. […]

1 Myth and 3 Truths About When to Use CPT Code 99211

You may think you know everything possible about CPT code 99211—or maybe you’re one of the people who thinks there isn’t much to know about this code. After all, some practices simply assign it to every service the nurse provides and move on. This strategy can backfire as audits of 99211 ramp up and payers […]
Concierge medicine

5 Considerations Before Shifting to a Concierge-Based Practice

As every medical practice staffer is aware, dealing with insurance companies, chasing down copays and processing denials can cause hours of wasted time. This has led some providers to consider transitioning their practices to a concierge model, where patients pay a fee (typically either annually or monthly) for membership. Although there are some options allowing […]
Telehealth billing

Want to Bill Annual Wellness Visits Via Telehealth? Here’s How

Navigating the telehealth billing rules can be fraught with confusion, even though you’ve been using the pandemic guidelines for nearly three years now. And with Annual Wellness Visits (AWVs) on the telehealth billing list, you must be careful to thoroughly document all of the elements, just as you would when patients are in the office. […]

5 Staff Training Tips to Help Sidestep QMB Billing Issues

Medical practices may see Medicare and Medicaid patients every day. What could be less common at your practice, however, is a patient who has both Medicaid and Medicare, known as a qualified Medicare beneficiary (QMB). All Medicare providers—not just those that accept Medicaid—are prohibited from charging QMB patients for cost-sharing. If you’re in this category […]
ERISA health insurance

How Will the PHE’s End Impact ERISA & Uninsured Patients?

When a patient’s claim gets declined due to non-coverage, the patient may tell you they’re taking advantage of longer enrollment grace periods that have been in place due to the public health emergency (PHE) and refuse to pay out of pocket. But as the PHE approaches its May 11 ending date, it’s a good idea […]
Prompt pay discount

When Prompt Pay Discounts Are OK (and When They’re Not)

As patients grow increasingly savvy about researching healthcare prices, they’re more likely to ask practices for discounts that apply to anything from office visits and radiology services to surgeries and dental procedures. As many practices are aware, not all discounts are created equal—some are legal, while others are not. Fortunately, prompt pay discounts are allowable […]
Good faith estimates

Keep These Timelines in Mind for Your Good Faith Estimates

Creating compliant good faith estimates for self-pay and uninsured patients means more than just handing patients a form with a number on it. You must also master the timing of the estimates you distribute—and if you don’t, the government could fine your practice. Why? Because the estimate needs to give the patient enough time to […]

How Practices Can Avoid the Most Common Incident-to Red Flags

When an advanced practice provider (APP) sees patients at your practice, your payer will reimburse you at 85 percent of the fee schedule amount—unless you bill using the incident-to rules, which can net you the whole fee schedule amount. To submit your claims under incident-to, you must ensure that the physician created the initial plan […]
ABN form

How to Collect for Non-Covered Services Under MA Plans

Most practices know the ropes of using an Advance Beneficiary Notice (ABN) of Non-Coverage: When a service might be denied and you want Medicare patients to understand what their financial responsibility may be, you have them sign the ABN. But what happens when you see a patient who has Medicare Advantage rather than a Part […]