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Prior authorization represented the biggest cost-saving opportunity for providers

Prior authorization represented the biggest cost-saving opportunity for providers

Prior authorization is a check conduct by some insurance companies or third-party payers in the United States before they agree to cover specific prescribed medications or medical procedures for patient. Prior authorization costs accounted for approximate two percent of overall medical industry spending on administrative transactions in last year 2019. Analyzing data from medical plans covering

Advancements in primary care fosters Value Based Care

Advancements in primary care fosters Value Based Care

Technological advancements in primary health care system have become quiet crucial in medical sector. Adoption of continual innovative technologies pertaining to medical care is one of the major driving forces. As these days the world has been infested by many infectious and other such allied diseases; due to inflated influx of migrants from high prevalent

How Do Oncology Practices Affect Mandatory Bundled Payment Models?

How Do Oncology Practices Affect Mandatory Bundled Payment Models?

One of the new bundled payment models from the Centers for Medicare & Medicaid Services (CMS) that is the Oncology Care Model has increased the interest and doubled the participation numbers among healthcare providers as many medical organizations participating than initially expected. Research-based study shows that many organizations are experimenting with value-based payment models that

Get Ready for Radiology Billing Changes in 2020

Get Ready for Radiology Billing Changes in 2020

The Centers for Medicare & Medicaid Services (CMS) recently published the final Medicare Physician Fee Schedule for 2020, drawing positive and negative reactions from various radiology groups. The American College of Radiology, said it was “disappointed” that CMS chose to finalize plans to implement a upgraded coding structure for office/outpatient evaluation and management (E/M) services.

Is it required to shift Value-Based Care in Primary Care Staffing Model?

Is it required to shift Value-Based Care in Primary Care Staffing Model?

The medical assistant is the only model for primary care staffing can be the most cost-effective for practices relying on fee-for-service revenue. But the this model will not be able to support value-based care and other sophisticated revenue arrangements, Premier recently reported. Physicians will have to reevaluate and tweak the arrangements of their clinical care

Strategies to maximize the effectiveness of Prior Authorizations

Strategies to maximize the effectiveness of Prior Authorizations

Using automated systems, proactive checks, and expert and dedicated staff are three ways that providers can reduce the bad effects of prior authorizations. Prior authorization is a strategy that payers use to control cost and ensure that their insured members receive medically necessary care. Advance approval from payers is required to deliver specific services or

Ambulance reimbursement: How to strengthen your Ambulance Billing?

Ambulance reimbursement: How to strengthen your Ambulance Billing?

The alterations between medical and ambulance coding are many. Not only are the procedure codes and documentation unique, but things that doctors and hospital coders take for granted do not apply in ambulance medical billing and coding. Ambulance medical billing service presents a unique set of compliance challenges. The ambulance industry over the past few

Basics of documentation for Mental Health Specialty

Basics of documentation for Mental Health Specialty

Mental health billing documentation has specific responsibilities to perform in order to receive reimbursement from the Medicare program. Medical billers have to ensure that the claims submitted are true and accurate, while justifying the medical record documentation for billed services. Mental health billing documentation is simple terms is the process of recording details about a

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