No Surprises Act passed to eliminate balance billing.

The No Surprises Act Part 2 – Second Interim Final Rule Released

By Raul Neyra / November 18, 2021 / 0 Comments

Reading Time: 6 minutes Background In part one, we discussed exactly what the “No Surprises Act” (NSA) is.  Passed as part of the Consolidation Appropriations Act of 2021 in December of 2020, the NSA is aimed at eliminating large unexpected or surprise medical bills. Those bills usually come from one of three sources – 1) an emergency where a […]

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The No Surprises Act

The No Surprises Act – What Is It?

By Raul Neyra / November 8, 2021 / 0 Comments

Reading Time: 4 minutes In a Kaiser Family Foundation survey, data showed that one-third of insured patients had received a surprise medical bill in the past two years. An additional 67% said they had concerns about receiving a surprise medical bill.  Data from Health Care Cost Institute showed that even when being treated at an in-network facility, one in […]

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Silent PPOs - Bad for Business

Silent PPOs – Bad for Business

By Raul Neyra / October 26, 2021 / 0 Comments

Reading Time: 4 minutes Silent PPO is a name used to describe when a contracted payer’s fee schedule is applied by a non-contracted payer or plan administrator to services rendered by a medical provider without that provider’s knowledge. How Silent PPO Happen Silent PPO is a complicated repricing scheme, around since the early 1990s, that sees the practice of […]

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Medical Credentialing Service

What is Credentialing and Why Is It Important?

By Raul Neyra / October 4, 2021 / 0 Comments

Reading Time: 3 minutes What is Credentialing? Credentialing is the process by which a practitioner’s license, education, training, experience, and other qualifications are verified in order for them to provide care or services in or for a health care organization.  This process’ role is to help maintain standards of quality in the medical community for the benefit of patients. […]

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Denied Medical Claims vs Rejected Medical Claims

Denied Medical Claims vs. Rejected Medical Claims

By Raul Neyra / September 16, 2021 / 0 Comments

Reading Time: 3 minutes Most of us are used to being billed for a variety of services rendered, such as for plumbing fixes. You receive a bill outlining the work done and you pay it. Simple. However, medical billing isn’t as easy as that. Providers don’t just send a bill to the insurance company and receive payment. It is […]

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medical coding

The Issue of Overcoding and Undercoding

By Raul Neyra / September 13, 2021 / 0 Comments

Reading Time: 3 minutes Medical coding is necessary for physicians to get reimbursed for services rendered. To get paid their contracted rate by insurance companies, physicians have to code procedures accurately to reflect the services rendered.  But the job of coding medical claims is complicated.  There are thousands of codes and compliance rules and you have to be able […]

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Medical Authorizations

The Difference Between Medical Authorizations and Referrals

By Raul Neyra / September 2, 2021 / 0 Comments

Reading Time: 3 minutes Managed care brought about so much more administrative work to the healthcare industry than there had ever been before. To make it even more complicated each insurance company has a different set of rules and guidelines that must be followed. What if a patient needs to see a specialist? Or needs to have a procedure […]

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Medical Claim Denials

Six Common Reasons Medical Claims Are Denied

By Raul Neyra / August 25, 2021 / 0 Comments

Reading Time: 4 minutes Medical claims denials will happen. But how many denials are you getting per month? More than 10%? More than 20%? Not sure?  A recent Healthcare Information and Management Systems Society (HIMSS) survey shows that 3 out of 4 (76%) of healthcare leaders say denials are their greatest challenge. And other research shows that 90% of […]

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RCM Outsourcing

RCM Outsourcing: How Outsourcing RCM Could Vastly Improve Your Business

By Raul Neyra / August 9, 2021 / 0 Comments

Reading Time: 4 minutes Do you have insight into your practice’s financial health? Do you know how much of your accounts receivable is older than 60, 90, or even 120 days? MGMA recommends that less than 14% of your A/R should be 90+ days old. They also show that 60 percent of the amount owed by patients is never […]

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Improving patient payment collection

How To Improve Patient Collections Easily

By Raul Neyra / July 27, 2021 / 0 Comments

Reading Time: 4 minutes Are you struggling with outstanding account receivables? Did you know that research shows practices only collect about 12% of outstanding balances at the time of service and collect nothing approximately 67% of the time? Also, it has been shown that the higher the outstanding balance, the less monies are collected. For example, about 40% of […]

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