Blog

Five Tips to Working with Blue Cross and Blue Shield of Illinois

August 5, 2021

Kurt Prins

Completing Medi-Cal forms can be challenging. Knowing what form to use based on the scenario and the time of request is important. There is also an alternative to the handwritten requirement.

Accurate Coding for Vaccines | 90471, 90472 and more|

July 26, 2021

Patti Lewis

From flu to tetanus, and now COVID-19, vaccines are among the most common outpatient procedures providers administer on a day-to-day basis. But they can also be complex to code and bill, and undetected mistakes can result in continual underpayment for services rendered.

Navigating Medi-Cal

July 6, 2021

Molly Evans

Completing Medi-Cal forms can be challenging. Knowing what form to use based on the scenario and the time of request is important. There is also an alternative to the handwritten requirement.

PAMA Reporting Regulations and Penalties

June 9, 2021

Monica Lelevich

The PAMA law brought a wide variety of changes to Medicare, including the method by which Medicare will calculate the rates it will pay under the Clinical Lab Fee Schedule. Data collected from the period of Jan. 1, 2019-June 30, 2019, must now be reported to Medicare between January 1 and March 31, 2022 or potentially face fines of more than $10,000 per day.

Take Steps to Stay Abreast of Evolving Telehealth Reimbursement

September 3, 2020

Jon Giuliani

The use of telehealth has skyrocketed due to the COVID-19 pandemic. However, long-term uncertainty about Medicare reimbursement and wide disparities in the way commercial payers and Medicaid programs reimburse for telehealth mean providers must be extra-vigilant to limit denials and underpayments. Financially hard-hit providers must consider new revenue cycle management protocols to ensure the best chance for full reimbursement.

Hospitals Can Improve Collections by Targeting CARC 24 Denials

March 27, 2020

Dan Low

Hospitals can quickly and dramatically improve collections by reducing Claim Adjustment Reason Code (CARC) 24 denials, or claims rejected due to incorrect Medicare and Medicaid submissions.

Order-of-Insurance Denials Costs Money, Damages Patient Experience

February 18, 2020

Dan Low

When it comes to payment denials, some of the most common and potentially damaging involve Claim Adjustment Reason Code (CARC) 22, or order-of-insurance coverage problems. CARC 22 denials reduce cash flow, trigger unnecessary patient invoicing, and may undermine customer goodwill and harm the hospital’s overall patient experience and brand.

CMS Imposes Prior Authorization for Specified Outpatient Procedures

February 4, 2020

Monica Lelevich

Medicare recently finalized a plan that will require hospitals to obtain prior authorization before performing certain outpatient procedures. Understanding these changes will be critical to avoid unnecessary denials beginning on July 1, 2020.

CMS Works to Ease RAC Audit Burden, Reduce Denial Backlog

January 22, 2020

Monica Lelevich

Long a thorn in the side of hospitals nationwide, Recovery Audit Contractor (RAC) program recently underwent substantial changes which CMS say will make the audit process significantly less burdensome for providers.

Support Act Creates New Bundled Opioid Treatment Payments

January 8, 2020

Patti Lewis

Hospitals on the front lines of the opioid epidemic have new tools to address the scourge of opioid misuse and addiction, including bundled Medicare reimbursements for holistic treatment services.
On Jan. 1, 2020, a bundled Medicare payment became available to hospitals to support comprehensive treatment of opioid disorders. The new reimbursement opportunity is one of several provisions in the act aimed at mitigating opioid misuse risk among Medicare beneficiaries.