Category: Blog

CMS Advanced Practitioner Professional Billing

Understanding CMS Advanced Practitioner Professional Billing

Many providers are still struggling with the non-physician practitioner (NPP) billing rules from the Centers for Medicare & Medicaid Services (CMS). Most facilities are now referring to NPPs as Advanced Practitioner Professionals or APPs. I get questions all the time about APP billing, and during audits many times it is found that the rules just […]
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Provider Billing Policies Hit Families Hardest

Beyond Benefit Design, Provider Billing Policies Hit Families Hardest

  What happens when record increases in health insurance premiums and deductibles put too much stress on patients’ pocketbooks? They delay needed care out of fear they’ll be unable to shoulder an unexpected medical expense for themselves or their families. Now more than ever, patients worry about their ability to cover out-of-pocket healthcare costs, a […]
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How Analytics Can Help Boost the Success of EHR

How Analytics Can Help Boost the Success of EHR Go-Lives

At HIMSS19, John Rekart, chief of quality management and informatics at the California Department of Corrections and Rehabilitation will show how homegrown analytics enabled a 25 percent post-implementation reduction in sentinel events. New electronic health record rollouts are infamously fraught with risk. At best, a they can cause workflow disruption, confusion among clinical staff and […]
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Non-Coverage Denials

Non-Coverage Denials: Cause and Cure

Explanation of Medicare Benefits (EOB) error message 96 Non-covered charge was the No. 1 reason for claims denials in December in all of Medicare Jurisdiction H, according to the region’s Medicare Administrative Contractor (MAC). “Prior to performing or billing a service, ensure that the service is covered under Medicare,” Novitas Solutions says on their website. This should be […]
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Physician Fee Schedule and EM

Getting Paid In 2019

Navigating the reimbursement landscape can be confusing for physicians because of the number of entities that exert influence on payments. For example, CMS uses the Medicare Physician Fee Schedule (PFS) to adjust Medicare payments, and sometimes these changes can have dramatic effects on doctor pay. Coding changes reward some types of care while de-emphasizing others […]
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The Benefit of Flexible Patient Payment Options

The Benefit of Flexible Patient Payment Options

The New Year brings new health plans, often with higher deductibles, and old bills that patients may be struggling to pay. According to 2018 data compiled by MedData, 83 percent of physician practices with fewer than five practitioners reported that their top collection challenge was slow payment among high-deductible plan patients. In this landscape, physicians […]
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5 Steps To Coding Success

Lesion Excision: 5 Steps To Coding Success

Lesion excision coding may seem complex, but reporting excision of benign (CPT Code 11400- CPT Code 11471) and malignant (11600-11646) skin lesions can be mastered in five steps. Step 1: Measure First, Cut Second: When assigning CPT® codes 11400-11646, you must know both the size of the lesion(s) excised and the width of the margins […]
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5 Major Challenges Facing the Healthcare Industry

5 Major Challenges Facing the Healthcare Industry In 2019

Healthcare is facing rapid changes. Here’s what you need to know to stay ahead in 2019 and beyond. The healthcare industry is facing many changes that pose new challenges to healthcare organizations big and small. In particular, the fast-evolving government regulations, technological innovations, and patient expectations create a new environment in which running a medical […]
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