In Audit
Jun 8th, 2016
The Centers for Medicare & Medicaid Services (CMS) has made a number of changes to the Recovery Audit Program for 2016. One of those changes is the length of time a provider has to submit a Discussion Request to a recovery audit contractor (RAC) following an automated review. CMS is also establishing Additional Documentation Request ...
Feb 1st, 2015
Although very different, editing rules are similar, and it’s important to understand what is appropriate to bill on claims. By Edie Hamilton, CPC, CPC-I The most frequently asked questions throughout my coding career have been about the differences between physician (professional) coding and outpatient facility coding. The questions have come from physicians, reimbursement and financial ...
In Billing
Sep 11th, 2014
What do you do when an error on a claim is discovered by someone in your practice after the claim has been processed? According to National Government Services (NGS), many physician practices correct such claims and then resubmit them. The problem with doing this is that these claims have already been finalized – thus, these resubmitted claims ...
Dec 1st, 2012
By Jim Denny, MBA Every practice knows that cash flow is a key indicator of financial health, but other key metrics should be evaluated to see the true state of a practice. By regularly looking at the number of days in accounts receivable (A/R), A/R greater than 120 days, collection rate, and denial rate, for ...
Jun 1st, 2012
Let under-utilized appeals systems work for your practice. By Heather M. Shand, CMAA, CBCS, CMB Sometimes, even if you do everything right, you may end up with denied claims. Rather than throw up your hands and walk away, you should appeal. Yes, it will mean extra work, but the results are worth it: Most of ...