In CMS
Sep 9th, 2019
The goals of value-based programs are to boost quality of care, promote health, and lower healthcare costs. The Centers for Medicare & Medicaid Services (CMS) is on a constant mission to transform the delivery of healthcare and how they reimburse healthcare providers. Former President Barack Obama’s healthcare law and subsequent legislation, such as the Medicare ...
In Audit
Sep 2nd, 2019
Lower denial rates are key to turning around large healthcare organization payment issues. When you are a large organization, the number of denied claims can be overwhelming and cost a staggering amount of money. To manage this can be a scary prospect — but fear not, we are here to help. Two things are crucial ...
Implement an enforceable assignment of benefits and protocols to protect providers against insurance underpayment and patient theft. Most members and contracted providers expect and/or take for granted Employee Retirement Income Security Act (ERISA) of 1974 law and assignment of benefits (AOB). But for non-participating (non-par) providers, the ability to receive insurance reimbursement directly, g...
Dodging them means your practice will better serve patients, decrease risks, and improve cash flow. In today’s environment of increasing regulatory oversight and ever-changing reimbursement policies, compliance requires concerted effort and plan. Although healthcare organizations are not federally mandated to implement a compliance and auditing program, it’s foolish not to. Done right, a complianc...
In CMS
Apr 26th, 2019
Insufficient documentation accounted for nearly 82 percent of improper payments for ostomy supplies in 2018, according to the Centers for Medicare & Medicaid Services (CMS). No documentation and medical necessity also are reasons for ostomy supply pay problems. Tips to Avoid Pay Problems CMS recommends the following to providers’ medical coders: Medical records must contain ...