Tag: Surprise Billing

Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

A new study by the health care system reveals a significant gap in consumer healthcare rights. Despite attempts to curb surprise medical bills, a large portion of insured Americans are still receiving unexpected charges. Adding to this problem is the high rate of coverage denials, leaving patients with substantial out-of-pocket costs and causing financial hardship […]
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Compliant Coding and Billing for Physicians: Expert Tips

Compliant Coding and Billing for Physicians: Expert Tips

The article explores common billing mistakes and offers tips for four healthcare services that can cause payment headaches for physicians. 1. Annual Wellness Visits vs. Physicals: Understanding Medicare Requirements Differentiating between Annual Wellness Visits (AWV) and Initial Preventive Physical Exams (IPPE) is crucial for accurate billing. Both are covered by Medicare for preventive care, but […]
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State Surprise Billing Laws Impact Out-of-Network Provider Charges

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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CMS Releases No Surprises Act State Enforcement Letters

CMS Releases No Surprises Act State Enforcement Letters

During a National Stakeholder Call on January 18, 2022, Ellen Montz—Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare and Medicaid Services (CMS)—announced that CMS had begun publishing state-specific letters (the “Enforcement Letters”) detailing anticipated Federal and state responsibilities with respect to enforcement of the […]
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5 Things rev cycle leaders need to know about surprise billing interim final rule

5 Things rev cycle leaders need to know about surprise billing interim final rule

  Understanding the qualifying payment amount and the initial information on the independent dispute resolution process “should be a short-term priority for revenue cycle leaders and their teams,” says attorney Harvey Rochman. Earlier this month, the federal government released an interim final rule outlining certain provisions of the No Surprises Act (NSA), which is designed […]
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