How to Get Out of Network Claims Paid?

If you see, Out-of-network refers to the provider’s non-participating relationship with the payer network and in such case, physicians may need to get prior approval from the carrier (i.e., pre-certification). Out-of-network (OON) plans are costly and many employers cannot afford to purchase them, so they have HMO-only coverage. The HMO has its own limitations and […]

Dermatology coding with E&M revision in 2021

Dermatology billing and coding is a very complex process due to detailed reporting, detailed information on procedures, and following multiple procedure rules. These complexities led to a lot of billing and coding errors. Moreover, in the past several time’s multiple changes have been made to dermatology codes, and staying up-to-date with the latest changes is […]

How Artificial Intelligence is optimizing RCM?

It is widely accepted among the practitioners that Revenue Cycle Management (RCM) has become increasingly more complex day by day due to the abundance of tagged data. However, applying AI to revenue cycle management could be the technology’s biggest break in the healthcare sector. For instance, Various manual and redundant tasks that are taking place […]

How to Overcome Telemedicine Challenges?

The telemedicine market is expected to grow at a CAGR of 14.9% over the forecast period 2019 to 2026 as more hospitals and healthcare facilities bring this technology online. Telehealth has the potential to reduce healthcare costs, improve patient outreach and health outcomes, and change the way providers treat their patients. There are many benefits […]

How does Medicare work when patient move to a different state?

Medicare, the federal government program that provides health insurance for people who are 65 or older and certain younger people with disabilities. Medicare has some standard billing codes for many treatments and services. Medical billing and coding are important facets to the health care industry. Regulatory changes happen frequently based on input and suggestions from […]

Assistive Technology Assessment (CPT code 97755)

CPT® 97755, Under Physical Medicine and Rehabilitation Tests and Measurements The Current Procedural Terminology (CPT®) code 97755 as maintained by American Medical Association, is a medical procedural code under the range – Physical Medicine and Rehabilitation Tests and Measurements. CPT code 97755, assistive technology assessment (e.g., to restore, compensate for an existing function or augment, […]

Janssen COVID-19 Vaccine CPT Codes

On JAN 19, 2021, the American Medical Association (AMA) announced that the Current Procedural Terminology (CPT®) code set is being updated by the CPT Editorial Panel to include vaccine and administration codes that are unique to the COVID-19 vaccine candidate under development by Janssen Pharmaceutica, a division of Johnson & Johnson. The CPT codes – […]

OPPS Final Rule

The Medicare Outpatient Prospective Payment System (OPPS) final rule for calendar year (CY) 2021 continues cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments (PBDs), and updates the overall hospital star ratings methodology, effective Jan. 1, 2021. Payment Update CMS will increase base payment rates under the OPPS by 2.4 percent […]

Patients’ Electronic Access to Health Information

CMS Rule Building on the CMS Interoperability and Patient Access final rule (CMS-9115-F), this proposed rule would place new requirements on Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs, and Qualified Health Plans (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of health care data, and streamline […]

Provider Credentialing Consultant

Provider credentialing is the one of the important administrative process which contribute significant in to the quality of medical care. It also plays an important role in providers revenue cycle management to reimburse the deserving amount from payers. Without credentialing, providers cannot perform credentialing verification effectively and efficiently. This is the reason, providers are willing […]