Category: Medical Billing

medicare-advantage-prior-authorizations-are-often-unnecessarily-denied

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

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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4-ways-to-improve-claims-efficiency-for-rural-providers

4 Ways to improve claims efficiency for rural providers

The Centers for Medicare & Medicaid Services (CMS) subsidizes healthcare in defined rural environments, paying encounter rates for provided services provided and the overhead required to provide them. However, it’s not free money. Rural health clinic (RHC) leaders must keep track of the services provided and submit yearly totals. They also must submit and process […]
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new guidelines for billing splitshared visits

Updates Clarify Medicare Split/Shared Billing

Know the facts for ensuring proper payment of these claims in 2022. New policy for split/shared evaluation and management (E/M) visits (including critical care services and prolonged services) was finalized in the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. Knowing the new guidelines for billing split/shared visits performed in the facility […]
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