Medicare Advantage (MA) has become a dominant force in the Medicare landscape, accounting for over 54% of overall Medicare enrollment. This trend is expected to continue, with penetration rates projected to reach 64% by 2033. However, the future of the Medicare Advantage market is not without its challenges. The Slowdown Begins While MA has experienced […]
Understanding Modifier 95: A Brief Overview Modifier 95 is a medical billing code used to indicate that a service was provided via telehealth. This modifier is essential for ensuring that healthcare providers receive appropriate reimbursement for remote services. Here are the key points about Modifier 95: Purpose: Modifier 95 is appended to the CPT or […]
Have you recently received a surprising medical bill or had your insurance coverage denials for a recommended treatment? Unfortunately, you’re not alone. A recent national survey by the Commonwealth Fund, a leading healthcare research organization, found that a significant number of insured Americans face these challenges. While many may choose not to contest these issues, […]
Medicare Advantage (MA) plans, a type of private health insurance that serves as an alternative to traditional Medicare, have long been a subject of debate within the healthcare industry and among policymakers. However, recent political developments suggest a growing appetite for MA reform, marking a significant departure from previous bipartisan consensus. A Rising Tide of […]
Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
A new study by the health care system reveals a significant gap in consumer healthcare rights. Despite attempts to curb surprise medical bills, a large portion of insured Americans are still receiving unexpected charges. Adding to this problem is the high rate of coverage denials, leaving patients with substantial out-of-pocket costs and causing financial hardship […]
A domestic medical billing audit is an operation that inspects and estimates the value and dependability of clinical documentation and the overall medical billing process. This technique closely examines health records upheld by the practice and evaluates medical billing data presented to the payers to make sure that the practice picks out, observes, and rectifies […]
A medical record is systematic documentation of a patient’s medical history and care. It usually contains the patient’s health information (PHI) which includes identification information, health history, medical examination findings, and Medical billing information. Medical records were traditionally kept in paper form, with tabs separating the sections. As printed reports were generated, they were moved […]
The medical billing process is a complex system that requires various steps to ensure accuracy and efficiency. Medical billing services work hard to make sure that medical bills are processed quickly and accurately, allowing for timely payments from insurance companies. 1. Patient Registration The medical billing process begins with patient registration, where the patient’s demographic […]
Value-Based Payment: Putting Patient Health First: When recommending a medical procedure, should doctors prioritize insurance reimbursements or patient health? The answer hinges on the payment model. In a fee-for-service system, providers are compensated for each individual service, potentially incentivizing excessive care. This model can lead to increased costs and harm patients through unnecessary treatments or medications. […]