Challenges in Insurance Reimbursement

Top 4 Challenges in Insurance Reimbursement Faced by Physicians

Access to beneficial healthcare is largely tied to insurance reimbursements for many Americans. Yet, despite their significance, physicians encounter various obstacles in obtaining these payments. Challenges involve inconsistent reimbursement schedules, payment audits, billing errors, unforeseen denials, lengthy appeals, and services falling outside coverage. These issues can hinder timely care, disrupt service continuity, and leave medical […]
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Top Challenges, Opportunities of Medical Coding and Billing

By April of last year, seemingly every news station in American was featuring the heroic efforts of physicians, nurses, and other clinicians fighting COVID-19. These providers transformed healthcare, implementing telehealth and virtual care, standing up new wards in hotels, sports arenas, and schools, and finding new ways to stretch precious supplies. But behind those transformations […]
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Physician Groups Say Changes to Medicare Payment are Key for Primary Care

The American College of Physicians (ACP) and other physician groups have written a letter to congressional leaders urging the implementation of essential changes to Medicare payments set to take effect Jan. 1. According to a news release, the Medicare Physician Fee Schedule for 2021 includes changes to Medicare payments for office visits and related evaluation and […]
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CMS Adds 11 Codes to Telehealth List

Physicians can now offer more services via telehealth and get paid. The Centers for Medicare & Medicaid Services (CMS) is adding 11 codes to the list of telehealth services payable under the Medicare Physician Fee Schedule (MPFS). Coverage is retroactive to March 1, 2020, and is effective for the duration of the public health emergency (PHE) for […]
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6 Must-Know Coding Updates In 2020

Becker’s ASC Review compiled a timeline of significant medical coding updates that have been proposed or implemented so far this year: January CMS began paying for certain angioplasty and stenting procedures in ASCs on Jan. 1, under its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule. Here are the Current Procedural Terminology codes […]
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Proposed Rule Introduces New CPT Codes For Cardiac Shunting, EKGS, And Lung Biopsies

Coders should also take note of the new HCPCS Level II codes CMS is considering. CMS released the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS) on August 3, introducing 39 new CPT codes, mainly for cardiovascular services. If finalized, the new codes will go into effect January 1, 2021. The proposed update includes five new codes for […]
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How 2021 E/M Coding Guidelines Could Ease Physicians’ Documentation Burdens

Physicians will potentially have a lighter documentation burden and more time to spend with patients in 2021 thanks to an overhaul of Medicare Coding guidelines for outpatient evaluation and management (E/M) services. “The whole point was to have people not document stuff that was not necessary, not relevant to the clinical management of the patient,” […]
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Check Your FESS Codes Claims for Improper Payment Adjustments

MACs may be applying the multiple endoscopy rules incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endoscopic procedures to the family of functional endoscopic sinus surgery (FESS) codes. Practices are now getting remittance advice […]
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E/M coding changes

A “bold proposal” to reduce the documentation burden on physicians was released as part of CMS’s 2019 proposed Medicare Physician Fee Schedule (PFS). This seemed to have begun as an effort to listen to stakeholders and address the problems of out-of-date guidelines, cloning, EHR misuse, and problems that have evolved since the inception of the […]
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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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