Category: Medical Billing

Professional Fee Revenue Cycle for Better ED Bottom Lines

7 Best Practices to Improve Professional Fee Revenue Cycle for Better ED Bottom Lines

Most healthcare organizations partner with physician services groups for niche coverage. While outsourced medical services are available across all specialties, common areas for external physician support include anesthesia, radiology, wound care, and emergency medicine. However, when outsourced physician services are used, challenges to ensure accurate reimbursement for both components of care—the hospital portion and the […]
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Hospitals to Assume Risk in Value-Based Care Models

Verma Presses Hospitals to Assume Risk in Value-Based Care Models

Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
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Coding CAR T Cancer Treatment Revolutionized

Coding CAR T: Cancer Treatment Revolutionized

Now that revolutionary cancer therapy, Chimeric Antigen Receptor T-cell (CAR T-cell), is covered, let’s take a look coding CAR T. Last month the Centers for Medicare & Medicaid Services (CMS) finalized the long-sought rules for coverage of CAR-T, novel cutting-edge, often curative treatments that utilize the patients’ own genetically modified immune cells to fight cancer. The […]
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Medicare Billing Privileges

CMS Pitches Sweeping Changes To Rules For Maintaining Medicare Billing Privileges

CMS’ proposed 2020 Medicare Physician Fee Schedule includes substantial changes to the rules for obtaining and maintaining Medicare billing privileges. A one-paragraph statement in the proposed rule calls for applying Medicare enrollment approval and revocation rules for opioid treatment programs to all physicians and other eligible professionals. The proposal would allow CMS to revoke Medicare […]
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Identifying & Addressing Common Medical Billing Errors

Identifying & Addressing Common Medical Billing Errors Pre- & Post-Payment

It is estimated that as high as 80 percent of medical bills contain errors.1 As healthcare costs continue to rise, so too is the need for healthcare payers to reduce overspending resulting from avoidable billing errors and improper claims reimbursement. Given the sheer volume of claims submitted each day, capturing and reconciling discrepancies based off of […]
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Union Lowers Medical Bills With Direct Negotiations

Union Lowers Medical Bills With Direct Negotiations

As companies shift more and more healthcare costs to their employees, the doormen, office cleaners, cafeteria staff and other members of the union 32BJ SEIU remain among the lucky few who pay no premiums and have no deductibles as part of their benefit plan. Keeping it that way has been no easy task. With each new collective-bargaining agreement, the […]
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Surprise Billing Solution

Providers, Insurers Parse What They Could Support – And What They Won’t – In Surprise Billing Solution

While both providers and insurers have found it difficult to agree on a solution to surprise billing, experts on both sides expressed support Tuesday for banning the practice – thereby forcing insurers and providers to work out payment disputes among themselves—when patients have gone to in-network hospitals. The approach, which has been tried in Oregon, […]
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5 Medical Billing Trends

5 Medical Billing Trends

The global medical billing outsourcing market is poised to expand for years to come as medical practices face challenges related to multiple payers and medical code representation, and large practices consolidate, according to a new report by Grand View Research. Five billing trends, based on the report: The global medical billing outsourcing market is projected to reach […]
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Fight Back Against Denied Insurance Claims

Fight Back Against Denied Insurance Claims: 5 Steps

Appealing a denied insurance claim can be frustrating, but don’t give up! By following these steps and understanding the process, you can increase your chances of getting the coverage you deserve. Here’s a detailed guide: 1. Understand Why Your Claim Was Denied (and Know Your Rights) Review the Denial Letter Carefully: This document should clearly […]
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