A recent report by the Department of Health and Human Services Office of Inspector General shines a light on significant billing issues for neurostimulator implantation surgeries. READ MORE
When you receive an overpayment demand letter from Medicare and disagree with the decision, there are two options for how to respond. You can submit either a rebuttal or an appeal. Your rebuttal and appeal rights will be clearly listed on the demand letter. READ MORE
Among the lesser known provisions of the No Surprises Act are those that seek to improve the accuracy of in-network provider directories maintained by insurance plans. While more complete rulemaking to address provider directories is expected later in 2022, the No Surprises Act laid out the general groundwork for both payers and providers to tackle the problem of out-of-date and inaccurate directories. The law also includes some protection for patients who rely on bad information in a directory and end up with a surprise out-of-network bill. READ MORE
For the fourth performance year in a row, the Centers for Medicare and Medicaid Services is making adjustments to the MIPS program as a result of the COVID-19 public health emergency. READ MORE
The Department of Health and Human Services has filed an appeal of the February ruling striking down the presumptive QPA policy in the independent dispute resolution process of the No Surprises Act. Several other lawsuits over the policy also are pending. READ MORE
New Medicare local coverage determinations may hinder the ability to be paid for anesthesia services during Epidural Steroid Injections for pain management. The LCDs for several Medicare Administrative Contractors went into effect in late 2021, and others are being rolled out in 2022.
Out-of-network surprise billing protections through the No Surprises Act have been in place since January 1, 2022, based on several final rules released last year. Now, additional guidance and FAQs have been released, along with an announcement about the impending launch of the online Independent Dispute Resolution (IDR) portal. Here’s a breakdown of recent updates.
One way to ensure hospital-owned physician practices are maximizing reimbursement is to outsource the billing of professional medical claims to medical billing companies who specialize in physician billing. Such outsourcing offers several key advantages for hospitals, as well as other corporate entities. Here’s why. READ MORE
A February ruling by Judge Jeremy D. Kernodle in the U.S. District Court for the Eastern District of Texas found portions of the independent dispute resolution process, established by the Departments of Health and Human Services, Labor, and Treasury during last year’s surprise billing rulemaking, to be inconsistent with the No Surprises Act. READ MORE
While bringing on new physicians or other clinicians is an important part of building your medical practice, enrolling them with commercial and government payers can be time consuming…and costly. The tedious process leaves plenty of room for error and delay, both of which can mean missed opportunity for payment. As you work through enrolling providers, here are a few tips to ensure a timely and successful process. READ MORE