Tag: denials

Medicare Advantage denials

Understanding the Rise of Medicare Advantage Denials: What Need to Know

Medicare Advantage (MA) plans, a type of private health insurance, have become increasingly popular among seniors. These plans offer additional benefits beyond traditional Medicare, but they also come with their own set of complexities.  One of the most significant issues faced by MA beneficiaries is Medicare Advantage denials for medical services. Recent data has revealed […]
Learn More
MA Prior Authorization Denials

Medicare Advantage Prior Authorization Denials on the Rise

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 […]
Learn More
Tips to Optimize Cardiology Billing and Coding Process

Top Tips to Optimize Your Cardiology Billing and Coding Process

Cardiology Medical Billing and Coding Process: To effectively handle these changes, cardiology practitioners might have to keep themselves informed about the modifications in payment regulations, modify their billing procedures as needed, and employ novel methods to enhance their compensation. Cardiology billing and coding can be challenging due to various factors, such as the complexity of […]
Learn More
The-State-of-Claims-and-Denials-in-2023

The State of Claims and Denials in 2023

How do you resolve a repeated and shooting up problem like claims denials? It’s been a fresher subject for revenue cycle management professionals for years that are only experiencing hotter with the growing pressures of staffing shortages, troubles with staff movement and instructing and developing policies and protocols at the government and payer levels. On […]
Learn More
New-Patient-EM-Denials

New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
Learn More
Prior Authorization

5 Tips for Making Prior Authorizations Less Burdensome

A 2016 study in the Annals of Internal Medicine found that for every hour physicians spend in direct face-to-face clinical time with patients, they spend nearly two additional hours on desk work. According to the American Academy of Family Physicians (AAFP), this administrative burden is one of the primary complaints of its members, and prior authorizations top the list of […]
Learn More
E/M coding and reporting

Evaluation and Management Codes…Why Bother?

Denials and how to not get discouraged with evaluation and management codes, and how to appeal There Is Little More Frustrating To Chiropractors And Billers Than Evaluation And Management Codes: While the service is required both clinically and documentation-wise, it is being bundled more and more often by third-party payers. If both the chiropractic manipulative […]
Learn More

Four Ways RCM Must Transform for the Shift to Value-Based RCM

Value-based care is driving transformation of many established operations within medical groups—and the revenue cycle is no different. It is likely that 2018 will be remembered as the year that value-based care became a financial reality for most U.S. medical practices. Those participating in MIPS (the Merit-based Incentive Payment System) received their first round of […]
Learn More
x