Importance of Insurance Eligibility Verification

A review as it relates to denials or delays in payments of a practice’s A/R (account receivables) may result in findings that insurance eligibility-verification is not being done correctly or at all by the office staff.  Today’s healthcare environment has produced confusion on insurance plans not only to physician practices, but to patient’s with the plan.  Many of the affected… Read more »

Revenue Cycle Management (Medical Billing and Collections) – Why Outsource?

Correct, detailed physician documentation, coding and billing is and continues to be of the upmost importance as we continue to see healthcare and reimbursement changes. As an example, the Centers of Medicare and Medicaid Services (CMS) in 2017 will say “bye-bye” to PQRS, Meaningful Use, and the Value based Modifier- (kind of). There is a constant need to keep the… Read more »

Medicare Provisions Related to the Merit-Based Incentive Payment System (MIPS)

ARE YOU INFORMED ABOUT MIPS? Medical Billing Collections Affected? Medicare Provisions Related to the Merit-Based Incentive Payment System (MIPS) The Quality Payment Program changes the way Medicare pays providers and offers financial incentives for providing high value care. The maximum Negative adjustments for each year are: 2019 — 4% 2020 – 5% 2021 – 7% 2022 and after – 9%… Read more »

Medicare’s Social Security Number Removal Initiative (SSNRI)

What is MACRA? Congress passed the Medicare Access and CHIP Re-authorization Act (MACRA) on April 16, 2015.  Section 501 of MACRA requires CMS to remove Social Security Numbers from Medicare ID cards and replace existing Medicare Health Insurance Claim Numbers (HICNs) with a Medicare Beneficiary Identifier (MBI). SSNRI: The Medicare Access and CHIP Re-authorization ACT (MACRA) of 2015 requires the… Read more »

Medical Billing Percentage Pricing – An Understanding

  Often when a Provider or Medical Group is looking to outsource their medical billing and collections for the first time, they are perplexed by the Percentage pricing model.  Since they have never outsourced before, and were depending on their own staff for handling the medical billing and collections activities, they are not in a position to understand the benefits… Read more »

5 Useful Tips on Denial Management

When it comes to active healthcare claims processing, it is essential to create a system that maximizes efficiency to handle denied claims. Most of the Healthcare entities get too worried when it comes to working claims, particularly when the claims are denied. It is essential to identify the prospective income lost and begin an effective medical claims management service for… Read more »

Consolidation in the Payer Market

Mergers and acquisitions in the US healthcare payer space has become the ‘talk of the town’ recently. The idea of consolidation was to build strength and boost growth by acquiring smaller companies. It is not a new concept, but has been happening for quite a long time in several industries. Some industries that have faced significant amount of consolidations include… Read more »

SGR Repeal – A new path forward!

One factor of reimbursment that highly concerned Healthcare Providers and Facilities was the SGR (Sustainable Growth Rate) payment cut proposal. However, it took a complete rollback when the US senate passed the SGR repeal bill on Apr 14, 2015. Hereafter, Providers need not bother about the SGR rate cut, which kept increasing every year and mounted to 21% at the… Read more »

CMS extends deadline for “Meaningful Use” and “PQRS”

  Since the inception of the Affordable Care Act (ACA), the US healthcare entities have been striving to improve the way patient care is provided by Providers. Evidently, it has brought out various reforms that focus more on the quality of service rendered to patients. In that list of reforms, a few that provide incentives are the Medicare Electronic Health… Read more »

Increased Medicaid Payments for PCPs

  The US is facing an acute shortage of Primary Care Providers and the number of PCPs per 10,000 people has steadily been on the decline. As part of the healthcare changes in 2013 which includes bringing millions of uninsured into the Healthcare net, Medicaid payments have been increased for qualifying Primary Care physicians for nearly 146 different Primary Care… Read more »