Category: Medical Billing

Scale, Efficiency Key to Provider Success in 2021 and Beyond

The COVID-19 pandemic has permanently changed the healthcare business model, causing providers to rely more on scale and efficiency to maintain financial stability in 2021 and beyond. At least those are the strategies industry leaders at Providence and UW Health are implementing to adapt to a more virtual, leaner environment as the pandemic continues, health […]
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Benefits of HIPAA-Compliant Emails

Benefits of HIPAA-Compliant Emails

Payment collection continues to be a challenge for healthcare providers. As we previously reported for Physician’s Practice, studies have indicated that doctors only collect 12% of what they are owed at the time of service, and in two out of three visits they collect nothing upfront at all. This means that physicians are sending bills to collect […]
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Congress Takes Steps to Curb Unexpected Medical Bills

Congress Takes Steps to Curb Unexpected Medical Bills

Most Americans tell pollsters they’re worried about being able to afford an unexpected medical bill. Late Monday, Congress passed a bill to allay some of those fears. The measure is included in a nearly 5,600-page package providing coronavirus economic relief and government funding for the rest of the fiscal year. Specifically, the legislation addresses those […]
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Congress Provides Relief on Medicare Payment; Passes Surprise Billing

Congress Provides Relief on Medicare Payment; Passes Surprise Billing

  The $1.4 trillion omnibus legislative package passed by Congress late Monday includes COVID-19 related relief for physicians, imposes new restrictions on surprise billing, and funds the government through fiscal 2021, which ends Sept. 30. The legislation mitigates budget neutrality cuts that would have slashed physician Medicare payment rates by 10.2% and extends the moratorium on the […]
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CMS Provides Updated Guidance on Billing For Covid-19 Monoclonal Antibody Treatments

CMS Provides Updated Guidance on Billing For Covid-19 Monoclonal Antibody Treatments

  CMS updated its COVID-19 billing FAQs on October 28 to address billing scenarios for potential monoclonal antibody treatments. The two new FAQs, which appear in section BB. Drugs and Vaccines under Part B, address billing for monoclonal antibody treatments provided in the hospital outpatient setting. CMS notes that if a monoclonal antibody product is granted an […]
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Updates on COVID-19 Billing and CS Modifier Audits

Updates on COVID-19 Billing and CS Modifier Audits

The pandemic continues to impact Medicare reimbursement. COVID-19 continues to make news on the regulatory front with two new directives from the Centers for Medicare & Medicaid Services (CMS), centering on testing for the deadly coronavirus and formal coding edits for the Medicare Administrative Contractors (MACs) on payments with the CS modifier. There’s a new […]
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CMS Revises Billing Instructions for Inpatient Covid-19 Claims

CMS Revises Billing Instructions for Inpatient Covid-19 Claims

CMS provided clarification on submitting inpatient claims for patients diagnosed with novel coronavirus (COVID-19) without a positive viral test, in an update to MLN Matters SE20015 released September 11. Earlier this year, the CARES Act increased the MS-DRG weighting by 20% for a COVID-19 diagnosis. Although the CARES Act doesn’t specify that the diagnosis must be supported by a […]
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Take a Consumer-Oriented Approach to Your Billing Cycle

Take a Consumer-Oriented Approach to Your Billing Cycle

The Covid-19 pandemic is transforming how physicians practice medicine and bill for it. Physicians who take a consumer-oriented approach to their billing cycle may adapt the best, says John Behn III, MPA, president of Stroudwater Revenue Cycle Solutions and a principal of Stroudwater Associates, a national healthcare consulting firm based in Portland, Maine. “We’ve seen […]
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A View into Proposed Medicare PFS and Policy Changes for 2021

A View into Proposed Medicare PFS and Policy Changes for 2021

  The Centers for Medicare & Medicaid Services (CMS) in the past week has proposed Medicare payment rules for outpatient services and physicians for 2021 and finalized payment rules for inpatient rehabilitation facilities (IRFs) and psychiatric facilities. Looking specifically at the 2021 Physician Fee Schedule (PFS) proposed rule, scheduled to be published Aug. 17, it […]
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Billing and Documentation Guide for Patient Care During COVID-19 Pandemic

Billing and Documentation Guide for Patient Care During COVID-19 Pandemic

  The COVID-19 pandemic has brought about robust changes to the traditional practice of healthcare in the United States. In a time of social distancing and widespread quarantining, regulatory bodies, including the Centers for Medicare & Medicaid Services (CMS), have adapted to the current environment. The most critical goal was to allow healthcare providers to […]
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