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
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
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
Anthem Blue Cross and Blue Shield recently announced a new policy of post payment reviews of professional ER claims billed with level 5 E/M codes. The new policy is being implemented to “ensure documentation meets or exceeds the components necessary to support its billing,” according to Anthem, and will begin August 1. Indiana and a few other states currently are excluded. READ MORE
Billing Anthem for anesthesia services administered during labor and delivery requires physicians to follow specialized guidelines, otherwise the claims will likely be denied. READ MORE
Anthem is once again tweaking policies for modifier 25, apparently still trying to get a handle on separately billed evaluation and management services that are provided on the same day as a minor surgery. READ MORE
Ideally, claims submitted to Medicare are always entered and processed correctly and then paid on time according to the Medicare fee schedule. But since we live in the real world, where mistakes can and do happen at any point in the billing process, here are four tips to help you identify and correct billing errors on Medicare claims. READ MORE
