Open Payments – Only 5.6% of physicians looked at their CMS records
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Open Payments – Only 5.6% of physicians looked at their CMS records

Accounts Receivable - Get paid for your claims

The Centers for Medicare and Medicaid Services (CMS) announced last week that in 2016, only 5.6% of physicians nationwide reviewed their data under the Medicare Open Payments program. Under the Open Payments program, drug and medical device manufacturers are required to report their financial interactions with licensed physicians – including consulting fees, travel reimbursements, research Read more

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Can you collect 20% that Medicare does not cover from a Medi-Medi patient?

Billing Statement Doctor

The short answer is “No”. Both state and federal law provide broad protections to Medicare/Medi-Cal dual eligible individuals, and prohibit billing a Medi-Cal patient in most circumstances. California’s Department of Health Care Services takes the position that a physician should first bill Medicare and then bill the Medi-Cal program for the services. Only if the Read more

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Advance Care Planning – New Payable Service

Advance Care Planning - 99497_99498

For the first time, the Centers for Medicare & Medicaid Services (CMS) made the Current Procedural Terminology (CPT) codes for Advance Care Planning (ACP) separately payable by Medicare. CPT codes 99497 & 99498 are used to report the face-to-face service between a physician or other qualified health care professional and a patient, family member, or Read more

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Medicare Incentive and Penalty Programs – A Brief Summary

Medicare Penalty Reduction

Over the past few years Congress has created a number of programs that call for payment incentives and reductions (referred to as “adjustments” by the Centers for Medicare and Medicaid Services) that impact physicians and their practices. These programs include: Sequestration Electronic Prescribing (eRx) Electronic Health Records (EHR) and Meaningful Use (MU) Physician Quality Reporting Read more

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Anatomy of Medicare Parts?

Medicare Part E

Everyone in the healthcare industry is anticipating the complete overhaul of the reimbursement methods to providers. Going down the list of the various Medicare parts, the next in sequence–alphabetically–is “E”. Hence, the new model is named “Medicare Part E”. Currently, Medicare reimburses providers as follows: Part A = Hospital, Skilled Nursing Facility, Hospice and Home Health Read more

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Are You Ready for Noridian – Your New Medicare MAC?

Medicare Transition to Noridian from Palmetto GBA

The Centers for Medicare & Medicare Services (CMS) first announced in September 2012 that Noridian Healthcare Solutions has been named the new Medicare Administrative Contractor (MAC) for Medicare Parts A and B in California, Nevada and Hawaii, as well as the U.S. territories of American Samoa, Guam and the Northern Mariana Islands (Jurisdiction E, previously called Jurisdiction Read more

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When is a “New Patient” Considered “NEW”?

Define a "New Patient" visit?

In 2012, the American Medical Association (AMA) revised its definition of a “New Patient” in its Current Procedural Terminology (CPT®) book. However, CPT®’s definition of a new patient did not mean Medicare would necessarily follow suit. Indeed, this change did not have any impact on Medicare Part B claims. CPT® defines a new patient as: Read more

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Hiring a Billing Company – Pricing Guideline And Contract Terms (Part 2)

Hiring a Billing Company

Pricing Guideline In “Hiring a Billing Company – Due Diligence (Part 1)” we discussed the steps in determining a suitable billing company for your practice. One key point in deciding the best fit is to ensure that you are going to save money and also increase your revenue. At this stage of your due diligence Read more

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Hiring a Billing Company – Due Diligence (Part 1)

Hiring a Billing Company

Are you looking for ways to improve the efficiency of your billing and increase your bottom line? A medical billing service could be the answer. Many physicians already look to medical billing companies for assistance with their billing and collection functions. Most billing companies offer billing and collection services, plus a wide range of other Read more

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You Have a Good Chance of Winning Your Medicare Appeals

Claims appealed and recovered from Medicare

Medicare recovery audit contractors (RAC) receive a contingency fee of 9% – 12.5% of any overpayment they find but must return that money when a determination is overturned on appeal. Physicians and hospitals have a record of success when appealing RAC overpayment decisions, according to an analysis by the Centers for Medicare & Medicaid Services Read more

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