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Providers should be preparing now for new surprise billing rules slated to take effect next year under the No Surprises Act. Starting January 1, 2022, healthcare providers will be subject to a new surprise billing law that makes it illegal for providers to bill patients more than in-network cost-sharing for out-of-network services and establishes an […]
A new study shows that Medicare physician reimbursement would have been $114K higher per physician a year if the doctor was integrated with a hospital system. Physician reimbursement for services performed by a doctor working for a hospital or health system is significantly higher than that paid to independent physicians for the same services, according […]
In January of 2011, Harvard Pilgrim and Tufts announced an attempted merger that was ultimately called off. Both companies found that they were stronger as separate companies than they would be if they were to merge. Now, a decade later, Harvard Pilgrim Health Care and Tufts Health Plan have officially merged. As of January 1, […]
The first element of MDM in 2021 office visits The 1st (of 3) elements of MDM: number and complexity of problems addressed. E/M changes for 2021 for codes 99202—99215 There are three elements in medical decision-making and this article describes the first of three. When selecting a level of service based on medical decision-making two of the […]
Knee ligaments connect the bones and cartilage, and hold and support the knee joint. Any mild tear in ligaments may severely limit the movement of the knees. Most commonly occurring from a sports injury, ligament damage may severely limit the movement of the knees and make it more unstable. This in turn may result in […]
Before the visit Prior to the visit, the front desk will be responsible for verifying eligibility, obtaining the necessary authorizations, and collecting co-pays and co-insurance upfront. 1. BE PROACTIVE IN CHECKING ELIGIBILITY. Denials are common but preventable. If your front desk staff checks eligibility early, you can avoid denials and delays later in the revenue […]
The quality of evaluation and management documentation is paramount for clinician reimbursement. The quality of evaluation and management documentation is paramount for clinician reimbursement. Evaluation and management (E/M) services are the most vulnerable to billing errors because it is complicated to select the proper code for the level of service captured in the documentation. A […]
Looking for a way to get a handle on Relative Value Units (RVUs) tied to Medicare payments or even use of RVUs in your own practice? Here’s the formula Medicare uses to calculate payments for the services you provide*: [ (Work RVUs x Work GPCI) + (Practice Expense RVUs x Practice Expense GPCI) + (Malpractice […]
• New Medicare Card: Claim Reject Codes After January 1 – Starting January 1, 2020, you must use Medicare Beneficiary Identifiers (MBIs) when billing Medicare regardless of the date of service: • We will reject claims submitted with Health Insurance Claim Numbers (HICNs) with a few exceptions • We will reject all eligibility transactions submitted with […]
The American Medical Association (AMA) has now weighed in with their E/M requirement modifications, which means that all payers will be affected in 2021. If you remember, Medicare announced plans to revamp the E/M coding structure in 2018 and was met with a quick response from the medical community. As a result, the Medicare changes […]
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