In Billing
Feb 1st, 2019
The Eight Circuit Court of Appeals upheld a lower court’s ruling regarding out-of-network payments by UnitedHealthcare (UHC). How Ruling Got Started UHC has a policy of offsetting payments for patients in a different plan when they are trying to recover what they considered an overpayment. These policies were put into effect in 2007 and were ...
In Coding
May 14th, 2018
Managing denials is more difficult in 2018 than it was in 2005, 2000, or 1998. Not because practices are necessarily receiving more denials from payers but because unlike the early to mid-2000s and 1990s, we are now posting payments via auto remit programs, so denials and underpayments get automatically applied without a coder/biller questioning the ...
Communication is essential to a smooth appeals process. Your practice was the subject of a special investigation unit (SIU) audit, and now the payer is asking for a refund. You have two choices: pay or appeal. If you disagree with the findings, the smart choice is to meet with the payer, appeal the findings, and ...
In Billing
Dec 19th, 2016
Provider agreements (or the ancillary documents) outline the formal processes to appeal payers’ payment decisions. You must review your agreement (or ancillary documents) with the specific payer to comply with the rules of the appeal process. A meritorious appeal may fail because you didn’t meet deadlines, follow the outlined procedures, or provide the necessary information. ...
Dec 9th, 2015
Medicare claims processing systems contain edits that identify exact duplicate claims and suspect duplicate claims. Duplicate claims are counterproductive and costly, and they can get you into hot water with your Medicare administrative contractor (MAC): Too many billing errors (of any nature) may result in your MAC imposing program integrity actions against your practice. So ...