In Audit
Nov 1st, 2018
By law, the Administrative Law Judge level of Appeals has 90 days to resolve appeals submitted to the ALJ level.  However, the Department of Health and Human Services (HHS) Office of Hearings and Appeals (OMHA) has been unable to keep up with the number of appeals submitted to them which has lead to a huge ...
In Coding
Aug 9th, 2018
Improve your claims payment success rate by understanding bundling and add-on code rules. Electrophysiology studies and arrhythmia ablation can be tricky to report due to the number of bundled and add-on codes. Here’s a step-by-step approach to coding these medical procedures with confidence. The Value of EP Studies Electrophysiology (EP) studies are used to both diagnose ...
In Billing
Jul 30th, 2018
Medicare claims that do not meet date format requirements will be rejected. The Centers for Medicare & Medicaid Services (CMS) has released date formatting guidelines for the CMS-1500 claim form, which are effective for claims received on or after July 30. When date formatting requirements are not met, Medicare Administrative Contractors will return claims as “unprocessable” with t...
Overcome billing challenges with processes that pave the way to a healthy revenue cycle. Federally qualified healthcare centers (FQHCs) are taking on a more prominent role in our healthcare system, providing primary care, as well as multi-specialty services including obstetrics/gynecology (OB-GYN), mental health, vision, and dental services. Because of the wide array of services provided ...
In Billing
Jun 25th, 2018
Clearing houses affect revenue flow through denials. Understanding them and their processes helps you speed your re-submissions. After a claim file is sent to the clearinghouse, an edit report is sent back to the practice, indicating claims and charge lines rejected with various edit problems. If the details in these edit reports are not attended ...