How to Achieve Success through Key Performance Indicators (KPIs)?
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How to Achieve Success through Key Performance Indicators (KPIs)?

Healthcare Consulting

STEP 1 – Assess your Current Situation Look for opportunities to analyze your progress. By tracking and comparing key performance indicators, or KPIs, you can identify and address issues with productivity, reimbursement, claims submission, and other processes. Days to final bill—number of days from the time of service until provider generates and submits a claim Read more

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How to Read an EOB / ERA

ERA/EOB - Reimbursement

Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient information privacy law and electronic patient information security law. However, HIPAA actually encompasses a number of regulations. As such, the federal government has published several “rules” that instruct the health care industry on how to comply with the law. Read more

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6 ICD-10 Changes for Primary Care


DIABETES Diabetes (codes E08 – E13) has greatly expanded in ICD-10. Physicians must document whether the diabetes is Type 1, Type 2, drug- or chemical­ induced, or due to an underlying condition. They must document the specific underlying condition, the specific drug or toxin, as well as the use of any insulin (Z79.4). ICD-10 requires 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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DMV Makes Changes That Affect Physicians

Road (DMV)

Department of Motor Vehicle (DMV) has made two changes that affect physicians. Effective January 1, 2014: DMV will only accept new DL 51 (1/2014 revision date) for commercial driver exams as a valid medical examination report for commercial driver license holders. Exams performed before January 1 can still be submitted on the older forms (revision Read more

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Blue Shield Changes Its Fee Schedule

Blue Shield Logo

In a notice sent to physicians on September 23, Blue Shield notified physicians about a change in the physician fee schedule. The new fees took effect December 1, 2013.  The insurer said that it would be increasing payment for evaluation and management services for preventive care. Additionally, Blue Shield notes payment increases for the more Read more

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Close Your Year With Confidence!

Checklist_End of Year

The following is a brief guide to getting ready for the new year: Allowables Do you have any new insurance contracted amounts (allowables) that you need to load in your practice management software for the new year? If you do, load these new fees in your practice management. And, if you do not have your allowable Read more

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Charging for “Free” Forms!

Charging for Forms

Due to rising practice cost and declining reimbursements, most physicians are looking into charging for services that they have done for free for years. One of the new sources of revenue is charging patients for completing forms. Charging patients for forms comes with a risk. Patients are not accustomed to paying for it and this 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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