Tag: Claim Denials

Payers-Wrongly-Cutting-Payments-To-Physicians-For-EM-Services

Payers Wrongly Cutting Payments To Physicians For E/M Services

Payers have been wrongly cutting payments to physicians for evaluation-and-management (E/M) services—often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding. Downcoding happens when a payer changes a claim to a lower-cost service than what was submitted by the physician, leading the practice to get […]
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Outsourcing-RCM-Services-can-Lead-to-Better-Outcomes

Outsourcing RCM Services can Lead to Better Outcomes

A report highlights pandemic-related impacts of the past year on revenue cycle challenges. As the labor shortage continues to hamper healthcare organizations, outsourcing has become a common strategy to mitigate costs. Nearly one-third of hospital and health system leaders (63%) have pursued at least one outsourcing solution, with revenue cycle functions at the top of […]
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10-Steps-Will-Help-You-Prevent-Denials

10 Steps Will Help You Prevent Denials

Healthcare policies and rules are continuously changing, and it’s important to stay on top of what all insurance carriers are doing and how their changes impact your practice’s revenue cycle. This, as well as managing your accounts receivable (A/R), is the best way to ensure your cash flow does not bottleneck and cause damage to […]
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MSP Billing Rules

CMS Issues Reminder on MSP Billing Rules, Appeal Options

  CMS is reminding organizations of Medicare Secondary Payer (MSP) billing and appeal processes after the agency inappropriately denied some claims. Organizations are advised that they must continue to provide services to patients who have open or closed secondary payer records on file or if Medicare inappropriately denied a claim, according to MLN Matters SE21002. Organizations are […]
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Billing Cycle

Take a Consumer-Oriented Approach to Your Billing Cycle

The Covid-19 pandemic is transforming how physicians practice medicine and bill for it. Physicians who take a consumer-oriented approach to their billing cycle may adapt the best, says John Behn III, MPA, president of Stroudwater Revenue Cycle Solutions and a principal of Stroudwater Associates, a national healthcare consulting firm based in Portland, Maine. “We’ve seen […]
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