Tag: Medicare

Beyond Benefit Design, Provider Billing Policies Hit Families Hardest

  What happens when record increases in health insurance premiums and deductibles put too much stress on patients’ pocketbooks? They delay needed care out of fear they’ll be unable to shoulder an unexpected medical expense for themselves or their families. Now more than ever, patients worry about their ability to cover out-of-pocket healthcare costs, a […]
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Medical Coding, Medical Billing, Denial Management, RCM

How Analytics Can Help Boost the Success of EHR Go-Lives

At HIMSS19, John Rekart, chief of quality management and informatics at the California Department of Corrections and Rehabilitation will show how homegrown analytics enabled a 25 percent post-implementation reduction in sentinel events. New electronic health record rollouts are infamously fraught with risk. At best, a they can cause workflow disruption, confusion among clinical staff and […]
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CO16 denial code

Non-Coverage Denials: Cause and Cure

Explanation of Medicare Benefits (EOB) error message 96 Non-covered charge was the No. 1 reason for claims denials in December in all of Medicare Jurisdiction H, according to the region’s Medicare Administrative Contractor (MAC). “Prior to performing or billing a service, ensure that the service is covered under Medicare,” Novitas Solutions says on their website. This should be […]
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Blockchain

HIT Think: How Blockchain Could Make an Impact In Healthcare

Blockchain, like other young and disruptive technologies, offers wide opportunities to impact healthcare, an industry that is primed for disruption. Despite being the largest sector of the U.S. economy, healthcare is plagued by slow systems, wasteful financing, and resource utilization and operational inefficiencies. To address these issues, innovative solutions like blockchain can alter the arithmetic […]
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Getting Paid In 2019

Navigating the reimbursement landscape can be confusing for physicians because of the number of entities that exert influence on payments. For example, CMS uses the Medicare Physician Fee Schedule (PFS) to adjust Medicare payments, and sometimes these changes can have dramatic effects on doctor pay. Coding changes reward some types of care while de-emphasizing others […]
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Eliminate Claim Denials For Medical Necessity

There are numerous reasons for claims denials but most of them come down to some form of documentation error, according to Karen Meador, MD, MBA, Senior Physician Executive and Managing Director at the BDO Center for Healthcare Excellence in New York, NY. Furthermore, most of the claims she has seen that “rise to the level […]
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The Benefit of Flexible Patient Payment Options

The New Year brings new health plans, often with higher deductibles, and old bills that patients may be struggling to pay. According to 2018 data compiled by MedData, 83 percent of physician practices with fewer than five practitioners reported that their top collection challenge was slow payment among high-deductible plan patients. In this landscape, physicians […]
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