Category: Medical Billing

learn-about-opps-changes-in-july-update

Learn About OPPS Changes in July Update

Please be mindful that several coding and billing alterations pertaining to outpatient claims have been backdated to either April or January. Numerous modifications to Medicare’s Outpatient Prospective Payment System (OPPS) in the July update closely mirror those in the Medicare Physician Fee Schedule Database (MPFSDB) update for the same quarter. These include the introduction of […]
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take-the-complexity-out-of-behavioral-health-coding

Take the Complexity Out of Behavioral Health Coding

The secret to ensuring both proper payment and compliance is in the details. Why is mental health coding so complex? Laurie Bouzarelos, MHA, CPC, asked and answered that question in her presentation “Coding and Billing for Psychiatry and Outpatient Mental Health Providers” at AAPC’s virtual HEALTHCON 2022, March 27-30. Bouzarelos manages to take much of […]
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mgma requests updates to independent dispute resolution portal | AllZone Management Services Inc.

MGMA Requests Updates to Independent Dispute Resolution Portal

The organization recommended CMS update the independent dispute resolution portal to improve communication between disputing parties and adjust the form field requirements. The Medical Group Management Association (MGMA) has asked CMS to update the federal independent dispute resolution (IDR) portal to streamline the arbitration process for determining an out-of-network payment rate for a surprise medical […]
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Medicare advantage prior authorizations are often unnecessarily denied

  A report by the Office of Inspector General (OIG) raises concerns about organizations prioritizing profits over patient access to care. Medicare Advantage organizations (MAOs) often delay or deny services for medically necessary care, even when prior authorization requests meet coverage rules, according to a report by the OIG. A concern with the Medicare Advantage […]
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7 data breaches affecting patient billing info

  In the last six months, several payers, providers and revenue cycle vendors began warning patients about data breaches that affected medical billing information. Here is a breakdown of seven instances: Adaptive Health Integrations, a company providing healthcare billing services, suffered a breach in October that exposed 510,574 individuals’ data. The incident is the third-largest […]
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