Using modifiers accurately is an important component in medical coding, billing, and reimbursement. Applying modifier 22 (Increased procedural services) can help increase reimbursement. Modifiers indicate that the work done by the provider does not exactly correspond to the CPT code descriptor. Appending incorrect modifiers or not appending the correct modifiers can attract audits, and lead
Medical Payments and Billing are also an aspect of Patient care. A negative payment experience could impact a patient’s overall impression of a healthcare organization. Improving patient satisfaction can benefit in patient retention, accelerating revenue flow and improving patient health. SIMPLIFY BILLING: A complex billing process is a significant hurdle in the collection. Complicated billing
Healthcare and medical organizations with the understanding of the importance of procedures perform streamlined and straightforward business operations to ensure that the services are executed effectively, securely thereby, following the substantial regulations of the healthcare industry. HIPAA compliance is very important regulation in healthcare industry. Fax services should have HIPAA compliant in medical billing services.
The first piece of prescription-drug pricing legislation emerged from a unanimous vote on the House Ways & Means Committee in April. That means the Prescription Drug Sunshine, Transparency, Accountability and Reporting (STAR) Act is well on its way to passage in Congress, either on its own or in any larger health care bill the House and
Why is credentialing important? Credentialing is the process of gaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization. Industry-recognized credentials help employers to validate the information and skills of potential employees and save time in selection of the skilled physicians for jobs applications.
Accountable care organizations (ACOs) are part of the foundation of the healthcare industry’s transition to value-based care and purchasing. The federal government says ACOs could do more to reduce costs and improve care quality. And the organizations can achieve the goals through downside financial risk. ACO programs with higher financial risk levels compared to the
Diagnosis coding is becoming more and more important. The shift from volume to value requires HCC coding for patient acuity not just diagnosis coding for medical necessity. As the healthcare reimbursement process shifts towards a Value-Based model, Fee-for-Service will continue. However, there are many other reporting mechanisms that will now utilize diagnosis codes. DEMOGRAPHICS +
Low-value health payer plans and short-term health plans are just to attract consumers for profits with fewer services being provided shortly. Those individuals who were between jobs or in other situations in which they could not obtain their health payer coverage were attracted by such short term health plans. But at least there is an
Improving the revenue cycle starts with clean up your medical coding. Codes should have to be right, or the claims your facility or practice submit will be rejected. If claim get rejected mean you don’t get paid on time, and either resubmitting or going through a lengthy appeals process, with no guarantee of full payment
CMS’s Existing Initiatives Protect Medicaid In 2014, CMS revised the Medicaid Provider Reassignment Regulation to provide for a new exception to the direct payment requirement for certain providers, which primarily include independent in-home personal care workers. This new regulatory exception authorized a state to make Medicaid payments to third parties on behalf of certain providers.