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
Patients who accumulate medical debt are getting some relief from credit reporting changes and a new four-point plan laid out by the Biden administration. Meanwhile, providers, whose bills patients are struggling to pay, are pursing more creative and patient-friendly ways to collect those balances. READ MORE
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
When claims are denied by Medicare, providers have the right to appeal the decision. In fact, providers can appeal a decision up to five times–all the way to a judicial review in U.S. District Court–if they disagree with the rulings. But not all denials merit an appeal, and when they do, each level of appeal is different and must be sent to a different contractor. Wondering if an appeal is your next step? Here’s how to know when you should appeal and at what level and where to send it. READ MORE
The Medicare Place of Service Workgroup recently revised the telehealth place of service codes to reflect the need for greater specificity in the industry. While Medicare itself has not identified a use for the update within their own billing guidelines, they’ve made changes because “the healthcare industry has a greater need for specificity than Medicare” and “this eases coordination of benefits and gives other payers the setting information they need.” READ MORE
In the final rule of the 2022 Medicare Physician Fee Schedule, CMS made several changes to their longstanding policies for split (or shared) evaluation and management (E/M) visits and Critical Care Services. Here’s an overview of the new policies, along with some documentation and coding suggestions.
READ MORE
The Centers for Medicare and Medicaid Services recently published the final rule of the Medicare Physician Fee Schedule for 2022. In addition to changing the payment rates for 2022, CMS also finalized changes to several payment policies. We’ve highlighted a few of the biggest for emergency physicians below. READ MORE
If the phrase “robotic process automation” (or RPA) has you picturing an R2D2-style droid floating around the medical billing office of the future doing filing and data entry, then you’ve got it all wrong. This futuristic-sounding tool can help with medical billing tasks, but its applications are available now and are already working behind the scenes across the medical billing industry. No metallic droids needed. READ MORE
A program announced by United Healthcare in early June to deny or limit coverage to emergency department claims retroactively deemed non-emergent may never get off the ground thanks to a provision in the Biden administration’s first regulation implementing the No Surprises Act. READ MORE
