Payer Contract

6 Tips to Negotiate the Payer Contract You Want

Payer contract negotiations don’t have to be painful. Consider these action items to help keep you focused, avoid payer pressures, and prioritize your organizational goals to ensure the right outcomes for your practice...
Medicare Exclusions

Don’t Pay the Price for Medicare Exclusions

Making the mistake of employing an excluded physician, nurse, nonphysician provider or administrator will lead to you facing thousands in civil money penalties — not to mention the money you’ll lose for services you’ve provided that can never be billed. Thinking that this can’t affect your practice is a HUGE mistake. In fact, the Office […]
Time-Based Coding

Tackle Time-Based Coding to Ethically Boost Your Reimbursement

If your practice isn’t using time-based codes correctly, you are leaving money on the table. Or worse, opening yourself up for massive fines per misuse. The truth is, most coders and their physicians steer clear of these codes out of fear of the consequences of getting it wrong.  But, there’s no need to avoid these […]
TRICARE Transition

TRICARE Transition Clarification

All Tricare West providers must secure new contracts with HNFS as UnitedHealthcare will no longer retain this contract. PGBA will remain the claims processor and there will be no disruption...
CMS’ Audit List

Stay Off of CMS’ Audit List

The number of physician practices being audited each year continues to rise. As a result, more and more providers committing fraud, or just making mistakes, are being identified and required to pay massive penalties or have even been sentenced to jail time.   In many instances, the violation wasn’t intentional, but because they had no way […]
Emergency Preparedness Plan

Implement a Compliant Emergency Preparedness Plan ….. Or Else

The Emergency Preparedness Rule final rule establishes standards to help you demonstrate that you stand ready for some of the frightening scenarios that can compromise the wellbeing of your patients. And the consequences of not complying can be as severe as...
Modifier 51 over 59

When To Use Modifier 51 over 59

When would I use modifier 51 instead of modifier 59? If you would have asked me that question 10 years ago, I would have told you not to use a 51 modifier because it causes bundling reimbursement. But 51 is now in your CPT book for when you are doing skin or endoscopic procedures. There […]
Infusion Administration

Recognize Infusion Administration Types to Ensure Proper Payment

Coding infusions is far from run-of-the-mill, and if you don’t get it right, you’ll likely see reduced — if not denied — claims. One of the key concepts when reporting this service is understanding the type of infusion you’re providing. Get it right, and your claim sails through, but get it wrong, and you’ll be […]
Incident-to Billing

Incident-to Means You Must Have Employment Relationship, or You Lose on Pay

Set up the wrong employment relationship with your nonphysician practitioners (NPPs), and you’ll forfeit the ability to bill their services incident-to your physicians and miss out on an additional 15% of their reimbursement. Or worse, you could bill incident-to incorrectly and get targeted for an audit and be required to pay back all the reimbursement […]
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