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 […]
CPT code 99211

Check These Four Documentation Rules for Reporting 99211

Your nurses are vital to your office’s operations, and the income they generate is vital as well. But if you don’t ensure that they document their visits properly, you could be throwing thousands of dollars out the window. That’s because payers and government auditors are reviewing documentation for nurse-visit CPT code 99211, and if they […]
outsourced medical billing

Evaluate Your Medical Billing Firm by Tracking These KPIs

Many practices find that outsourcing the billing function can help improve workflow at the medical practice, reduce errors, process claims faster and boost profitability. But if your billing partner isn’t providing you with reports, you may not be able to measure the most important key performance indicators (KPIs) that help you evaluate whether the relationship […]
No show patients

5 Strategies Help Reduce Medical Practice Patient No-Shows

No show patients have an annual industry impact estimated at $150 billion, and cost your practice about $200 per unused timeslot. In fact, some experts say practices lose an average of 14 percent of their potential earnings each year due to missed patient visits. Not only that, but no-shows mean that patients don’t get much-needed […]
risk adjustment

Risk Adjustment: Are You Self-Auditing ICD-10-CM Codes?

Medical practices can get paid more for Medical Advantage claims by accurately reporting patient risk—but the main way insurers evaluate risk is through your diagnosis codes. And if your practice isn’t performing ICD-10-CM self-audits, you could be underrepresenting your risk and shorting your practice significant income without even knowing it. Background: Risk adjustment is a […]
revenue cycle

Build the Ideal Revenue Cycle Team With This Quick Primer

The best way to ensure that you bring maximum revenue into your practice is to involve several key team members in the revenue cycle process so you can master every step along the way. And once you identify the participants, you’ll need to train them properly to keep the entire team running at maximum potential. […]
Advance beneficiary notice

Keep These ABN Formatting Tips in Mind to Stay Compliant

To keep reimbursement flowing into your practice, you must understand how to complete an Advance Beneficiary Notice (ABN) of Non-Coverage. But having a high success rate with your ABNs goes beyond filling out the fields correctly. You must also use the right paper size, font, and ink color, or you may end up having to […]
provider directory

Cut Your Risk: Update Provider Directory When Providers Leave

Every practice manager knows the importance of creating policies and processes to follow when a new provider joins — but it’s important to remember that you must also create know what to do when a provider leaves your practice. And even if you have a list you’ve been using for years, there’s one item that’s […]
denied claim appeal letter

Include These 5 Items in Your Appeal Letter to Achieve Success

Every medical practice has been there: You get a notification from an insurer that your claim is being denied, downcoded, or held for more information. In many cases, this can mean thousands in lost reimbursement for a service you’ve already provided. Therefore, your best bet is to appeal inappropriate denials so you can recoup the […]