Tag: medical-billing


Four Key Payment Trends That Impact Pediatric Practices

For a modern medical practice, efficiency is everything. Labor costs continue to increase, putting a pinch on practices that are still recovering from pandemic shutdowns. An August 2022 snapshot of practices shows that, although physician productivity is increasing, expenses are growing faster than reimbursements. Every person in the practice must work at peak efficiency, from […]
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State Surprise Billing Laws for Out of Network Payment | Case Studies | AllZone Management Services Inc.

State Surprise Billing Laws Impact Out-of-Network Provider Charges

Provider charges for out-of-network care increased by $1,157 after the passage of state surprise billing laws that allow arbitrators to consider provider charges in a surprise billing dispute. State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges […]
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New EM Billing Guidelines for unreimbursed Services | Case Studies | AllZone Management Services Inc.

New E/M Billing Guidelines for Unreimbursed Services

Recent changes to evaluation and management (E/M) billing guidelines that allow physicians to bill for previously unreimbursed services are producing higher revenues for longer patient visits, according to results of a new study. The study in JAMA Network Open looks at the financial impact of CMS’s 2021 expansion of its time-based billing guidelines to include […]
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Value-Based Payment makes up 6.7% of Primary Care Revenue

Value-based payment is severely lacking as a percentage of total medical revenue across practices as providers face scheduling and billing challenges. The transition to value-based payment is moving at a snail’s pace despite healthcare’s long journey with the transition away from fee-for-service, new survey data indicates. Value-based payment made up just 6.74 percent of total […]
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Cancer Centers Fail to Comply with Hospital Price Transparency Rule

Failing to post files in a machine-readable format was the most common violation of the hospital price transparency rule among NCI-designated cancer centers. Less than one-third of hospitals with National Cancer Institute (NCI) cancer center designation were fully compliant with the CMS hospital price transparency rule, according to research published in JAMA Surgery. The price […]
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High Out-of-Pocket Costs Led to Low Patient Collection Rates

Self-pay after insurance patient collection rates dropped from 76 percent in 2020 to 55 percent in 2021 as the share of out-of-pocket balances over $7,500 grew. Patient collection rates at hospitals declined and bad debt increased when out-of-pocket bills reached $7,500, according to a report from Crowe Revenue Cycle Analytics (Crowe RCA). The report reflects […]
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Coding Drives Up Medical Billing Costs in US

Another study confirms that medical billing costs in the US significantly exceed those in similar countries, but researchers now know why: coding drives up US administrative spending. Complex coding structures in the US are driving up medical billing costs in the US, making it one of the most expensive countries to get paid, according to […]
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How Ambulatory Surgery Centers Lower Payer Outpatient Spending

Payers can reduce surgical costs by 59 percent by shifting eligible members from the hospital outpatient setting to ambulatory surgery centers. Ambulatory surgery centers are care sites that offer surgical procedures, diagnostics, and preventive care services, according to the Ambulatory Surgery Center Association. These sites are not provider offices, rural healthcare clinics, or urgent or […]
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CMS Asks Medicare Advantage Plans to Relax Prior Authorizations

The agency emphasized relaxing prior authorizations that could impact transferrals between general acute-care hospitals and longer-term care facilities. CMS has requested that Medicare Advantage organizations relax or waive prior authorizations due to the impact of the coronavirus Delta variant. “The ability of hospitals to transfer patients to appropriate levels of care without unnecessary delays or […]
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