Tired of the denial merry-go-round with payers? Is your staff tearing their hair out, along with you? In today’s healthcare landscape, receiving a denied claim can be tricky business if you don’t understand how to appeal a claim. To appeal a denied claim, one must first understand the type of
Struggling with prior authorization denials? Check these quick improvement tips! Read More »
Coding compliance is crucial for all healthcare billing and documentation best practices. It ensures the integrity of medical records, accuracy, and adherence to regulations. This is vital for representing a patient’s health profile accurately, securing proper reimbursements, and avoiding legal issues. In today’s intricate healthcare environment, maintaining coding compliance is
CODING COMPLIANCE – BULLETPROOF YOUR PRACTICE Read More »
The world of Medical Coding has grown exponentially over the past ten years, and with that, so have coding errors, unfortunately. Just read a recent Comprehensive Error Rate Testing (CERT) Report from CMS for your state or the country, and it is self-explanatory. CMS created the CERT program to measure
TOP CODING MISTAKES IN 2025 Read More »
Is your practice losing money to Payer underpayments? Is your staff overwhelmed and unable to even review if you have been paid according to Payer contracts? You’re not alone! Payer underpayments occur when providers/entities receive less than expected from payers even when there is a contracted rate in place. Payers
As Dorothy stepped onto the yellow brick road with Toto, realizing they weren’t in Kansas anymore, so are we as a people in the healthcare landscape, as we embrace Artificial Intelligence. Over the next few years, AI will be a major part of the healthcare landscape and a dynamic process
Lions and Tigers and AI, Oh My – How Will AI Improve Coding and Billing in Your Practice Read More »
Payer denials have become a focal point in healthcare over the past year and with good reason, both Medicare (CMS) and Commercial payers like United Healthcare (UHC) and Aetna have denied more claims in 2024 for a myriad of reasons. Over the past three years, there has been over a
MASTERING DENIALS MANAGEMENT Read More »
Every year the Centers for Medicare & Medicaid Services (CMS), rolls out a new proposal of cuts to the Medicare Physician Fee Schedule or (MPFS), and on July 10, 2024, CMS did just that, they rolled out a rather shocking reduction of 2.8% to the MPFS for January 1, 2025
CONSEQUENCES OF CUTTING MEDICARE PHYSICIAN REIMBURSEMENT IN 2025 Read More »
With the recent release of CMS’s 2023 Improper Payment Report came some interesting results, of note are where Primary Care and the state of Florida land on Error Rates. The report indicates that after a thorough review by CMs, Primary Care was at the top of the list for most
Coding and Documentation – What Primary Care and Florida Have in Common Read More »
Well, here we are at the beginning of the fourth quarter of 2024 and CMS has graced us with their annual as I call it “The Come to Jesus Report”, as it highlights ALL the Coding, Billing, Documentation errors, and Service Types, across all states. It is a good read,
In January of this year, CMS expanded the Two-Midnight Rule (TM), which requires that a patient be admitted as inpatient when the clinician determines the patient requires more extensive treatment and services will encompass more than Two Midnights, versus the “old days” of being held in observation status as an
THE 2024 TWO MIDNIGHT RULE AND WHY PAYERS ARE SO CONCERNED Read More »
