Reading Time: 3 minutes We all have witnessed how the COVID 19 Pandemic has brought on new, little-known terminology to the healthcare forefront. Terms like telehealth and telemedicine have now become more mainstream in the healthcare community and not many are aware of the subtle differences in definition. What is Telehealth? Telehealth is defined as the broader method […]
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Reading Time: 3 minutes A recent MGMA poll, asking “How have your days in A/R changed in 2021?”, found that 49% of respondents said their time in A/R has increased in 2021. Thirty-seven percent (37%) said they stayed the same, but is that good? Only 15% said that it had decreased. It is well known that the longer a […]
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Reading Time: 3 minutes Until now, costs for healthcare were anything but transparent. A majority of people receive medical services without a clear understanding of what the charges will be, how much their insurance company will cover, and that prices can be vastly different from hospital to hospital. However, this situation is changing. New rules from CMS, which are […]
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Reading Time: 3 minutes Medical Group Management Association (MGMA) released findings from their Stat poll, conducted on August 10, 2021, regarding medical practices being forced to pay fees to receive EFT payments from payers. According to their research, 57% of respondents, when asked “Are insurers charging your practice fees you didn’t agree to when sending payments via EFT?”, responded […]
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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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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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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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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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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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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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