Factor in the pros and cons of each to make an educated decision for your practice. If you are wondering whether your provider should be in or out of network with certain insurance plans, take a deep breath and remember: It’s different for every practice, so weigh the pros and cons. Out-of-Network Insurance Providers may ...
Make a point to learn drug coverage and payer requirements for billing. It’s essential not to confuse vaccine injections with injectable medications. Injectable medications, for example, are reported with HCPCS Level II codes and vaccines are reported with CPT® codes. But that’s not all: In many instances, injectable medications require prior authorization — and the ...
Insurance verification and precertification play a big part in payment. Insurance verification and precertification play a major role in a practice or hospital’s revenue cycle management. Without these two fundamental steps, there is a high chance you’ll miss covered charges, eligibility, and patient liability. Each of these can negatively affect a provider’s accounts receivable or ...
Shed light on the new Medicare form and its effect on midnight madness. Every Medicare patient who receives observation care in the hospital for more than 24 hours must receive a Medicare Outpatient Observation Notice (MOON), form CMS-10611. The Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires all hospitals ...
In Billing
Dec 5th, 2017
There’s usually a reason and a solution for every denied claim. Claim denials are inevitable. The first step to work through them is understanding the most common denials, such as: bundling; global denials; multiple frequency denials; and no plan coverage denials. Bundling Unbundling occurs when a service is billed using individual codes when a single, ...