MedTrainer

NOVEMBER 2, 2023

This critical responsibility rests on the shoulders of the healthcare compliance officer. Their duties span across several areas, from ensuring adherence to laws to navigating the complexities of medical billing protocols. What Is the Primary Role of a Compliance Officer in Healthcare?

Compliance Officers 52

Compliance Officers Compliance HIPAA Regulatory Compliance 52

Medisys Compliance

JULY 25, 2022

Recently published watchdog report found that private Medicare plans routinely rejected claims that should have been paid and denied services that reviewers found to be medically necessary. For detailed understanding we shared observations of OIG where they found that some of the claims were wrongly denied by private Medicare plans.

Medicare 52

Medicare Medicare US Department of Health and Human Services Medical Billing Outsourcing 52

Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located.

COVID-19 52

COVID-19 Medicare Medicare Medical Billing 52

Medisys Compliance

MAY 5, 2022

On 22 nd April 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update Medicare enrollment and eligibility rules that would expand coverage for people with Medicare and advance health equity. Sections 120 and 402 of the CAA made two key changes to Medicare enrollment rules.

Medicare 52

Medicare Medicare Medical Billing Outsourcing Medical Billing 52

Medisys Compliance

MAY 20, 2024

Payer type: Private insurance companies, Medicare, and Medicaid have their own reimbursement structures. Payer Websites: Insurance companies and government agencies (Medicare, Medicaid) often publish reimbursement rates on their websites.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Medical Billing Services Medicare 59

Healthcare IT Today

JUNE 29, 2023

The following is a guest article by Isaac Smith, Billing, Coding, and Reimbursement Specialist at Medcare MSO ASCs are types of medical facilities that are subject to stringent regulations. However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

Healthcare Compliance Blog

APRIL 12, 2022

By pleading guilty, the business owner admitted that she willfully failed to deposit the Federal Insurance Contributions Act and Medicare (FICA) taxes and income taxes that were withheld from her employees’ wages. However, instead of forwarding those taxes to the government, she kept them for her business.

Medical Billing 59

Medical Billing Fraud Governance Medicare 59

Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

Medicare 52

Medicare Medicare Medical Billing Outsourcing Health Outcomes 52

Medisys Compliance

JUNE 10, 2022

Medicare covers limited chiropractic services when performed by a chiropractor who is licensed or legally authorized to furnish chiropractic services by the State or jurisdiction in which the services are furnished. In this article, we shared coding guidelines and Medicare coverage for Chiropractic Manipulative Treatment (CMT).

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Medisys Compliance

JUNE 20, 2022

Under Fee-for-service (FFS) Medicare, home infusion therapy (HIT) involves the intravenous or subcutaneous administration of drugs or biologicals to an individual at home. Medicare Coverage. Only a qualified home infusion therapy supplier can bill for services under the new home infusion therapy services benefit.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Medisys Compliance

MARCH 7, 2024

Understanding CPT Codes CPT codes are alphanumeric descriptors assigned to medical procedures, services, and supplies provided by healthcare professionals. These changes reflect emerging procedures, innovative technologies, and revisions to existing medical practices.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Regulatory Compliance Compliance 59

Medisys Compliance

MARCH 14, 2023

DRGs are a payment classification system used by Medicare and other insurance providers to categorize patients into groups based on their diagnosis, severity of illness, and the resources required for their care. Hospitals are paid a fixed amount for each DRG, regardless of the actual cost of the care provided.

Payment Systems 52

Payment Systems Medical Billing Medicare Medicare 52

Medisys Compliance

SEPTEMBER 16, 2022

Similarly, incorrectly applied dermatology billing modifiers on a claim will result in denials. Experienced dermatology medical billing and coding services providers can assist practices in filing clean claims by assigning the appropriate codes and modifiers to support the services rendered. ” Modifier 50 – Correct Usage.

Medical Billing 105

Medical Billing Medical Billing Outsourcing Medicare Medicare 105

AIHC

MAY 31, 2022

health care system relies heavily on third-party payers to pay the majority of medical bills on behalf of patients. Health care insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs. billion reduction of Medicare Fee-for-Service (FFS) improper payments over seven years.

Fraud 52

Fraud Compliance Officers Compliance Medicare 52

Medisys Compliance

MARCH 26, 2024

Medisys Data Solutions (MDS) , a leading medical billing company, understands these challenges. This guide explains basis of Holter monitor billing, empowering cardiology providers to optimize their revenue cycle. We offer a free consultation to assess your specific needs.

Medical Billing Outsourcing 64

Medical Billing Outsourcing Medical Billing Governance Medical Billing Services 64

Medisys Compliance

JULY 18, 2022

In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare covered SNF stay be included in a bundled prospective payment made through the Part A Medicare Administrative Contractor (MAC) to the SNF. This practice created several problems. To summarize.

Medical Billing 52

Medical Billing Medicare Medicare Medical Billing Outsourcing 52

Medisys Compliance

OCTOBER 8, 2023

Documentation: Comprehensive and accurate documentation of the patient’s condition, treatment plan, and progress is essential for proper billing and to demonstrate medical necessity. Telehealth Billing: In recent years, telehealth has become a vital platform for delivering mental health services.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Medicare Medicare 59

Medisys Compliance

MAY 30, 2022

The Physician Certification Statement (PCS) is the written order certifying the medical necessity of non-emergency ambulance transports. The regulations governing PCS requirements are specified in the Code of Federal Regulations at 42 CFR 410.40(d). These regulations are the basis for Medicare guidelines. Reference: [link].

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Medicare Medicare 52

Medisys Compliance

MARCH 31, 2023

Ohio Medicaid is a government-sponsored healthcare program that provides medical benefits to eligible individuals in Ohio. License or certification: You may need to provide proof that you are licensed or certified to practice in your field, such as a copy of your nursing license or medical degree.

Medicaid 52

Medicaid Medicaid Licensing Medical Billing Outsourcing 52

Medisys Compliance

MARCH 19, 2024

This comprehensive guide aims to explore the details of MAT billing, equipping providers with the knowledge necessary to navigate this complex terrain with confidence and accuracy. Looking to streamline your billing process? With our expertise, we ensure accurate billing for delivered services, including comprehensive support for MAT.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Health Services Administration Public Health 59

Innovaare Compliance

AUGUST 8, 2023

Inadequate healthcare compliance reporting : Third-party compliance reports often fail to report whether hospitals are complying with the Hospital Price Transparency Rule due to communication errors. However, these codes have proven to be insufficient, in terms of bundling services, due to these written notations.

Medical Billing 40

Medical Billing Compliance Hospitals Doctors 40

Medisys Compliance

JULY 11, 2022

The prohibitions on balance billing and cost-sharing protections vary among providers depending on the type of services they furnish and their practice settings. We shared new surprise billing requirements for reference only. If you need any assistance in billing, contact us at info@medisysdata.com/ 302-261-9187.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Health Insurance Medicaid 52

Medisys Compliance

APRIL 25, 2023

Need of Choosing Oncology Billing Company As an oncology practice, selecting the right billing company is a crucial decision that can significantly impact your financial success and regulatory compliance. This article will discuss key factors in choosing oncology billing company. Let’s discuss them in detail: 1.

Regulatory Compliance 52

Regulatory Compliance Compliance ACA Medical Billing Outsourcing 52

MedTrainer

FEBRUARY 20, 2024

Insurance credentialing is the process where a healthcare organization registers a healthcare professional through specific insurance networks or government payers , like Medicare or Medicaid, to receive reimbursement for services rendered during a patient’s visit. What is Insurance Credentialing?

Licensing 52

Licensing Medical Billing Compliance Medicaid 52

Medisys Compliance

MARCH 27, 2023

These terminologies are briefly discussed below for better understanding: Provider enrollment: This refers to the process of enrolling a healthcare provider with an insurance plan or government program, such as Medicare or Medicaid. appeared first on Leading Medical Billing Outsourcing Services Company in the USA.

Malpractice 52

Malpractice Medical Billing Outsourcing Governance Patient Satisfaction 52

Medisys Compliance

APRIL 11, 2022

Complete documentation will support all procedure codes your billed and will provide complete picture for payers. In this article, we shared list of required documents for ambulatory surgery centers who are beneficiaries of Medicare. Pre-operative medical record documentation. Post-operative orders for drugs and biologicals.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Informed Consent Nurses 52

Medisys Compliance

OCTOBER 30, 2023

In this article, we will explore the world of mental health billing and credentialing services, focusing on the unique needs of solo practitioners and how outsourcing can help streamline these crucial processes. Mental health credentialing is the process of becoming an approved provider with insurance companies or government health programs.

Medical Billing Outsourcing 59

Medical Billing Outsourcing Medical Billing Malpractice Licensing 59

AIHC

MARCH 2, 2023

Written by: Nancie Lee Cummins , CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This is part 2 in the Leadership essay series from members of the American Institute of Healthcare Compliance (AIHC). I do a lot of training of compliance officers and realize the time that is being spent could be improved.

Compliance Officers 52

Compliance Officers Compliance Fraud Medical Billing 52

Health Care Law Brief

NOVEMBER 9, 2021

By way of background, the No Surprises Act and its implementing regulations provide new federal protections against surprise medical billing. In addition, while some enforcement discretion has been signaled, as currently drafted, the Part II Rules arguably do not provide sufficient leeway to address these compliance challenges.

Medical Billing 75

Medical Billing Due Diligence Compliance Patient Satisfaction 75

Medisys Compliance

FEBRUARY 28, 2022

When practice deals with government and various private insurance carriers and that too for various billing scenarios, each denial is different. A study by the Medical Group Management Association found the cost to rework a denied claim is approximately $25. It is the process where every unpaid claim is investigated.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Medical Billing Services Governance 52

Healthcare IT Today

SEPTEMBER 19, 2023

Eden Avraham-Katz, VP of Legal & Compliance at 1upHealth While I appreciate the efforts to simplify the prior authorization process with FHIR APIs, the underlying issues with prior authorization are fundamentally systemic.

Hospitals 126

Hospitals HIPAA Nurses Governance 126

AIHC

NOVEMBER 3, 2021

How would you feel if you knew your doctor shared his/her password to your personal medical records with an unauthorized user? What if someone in medical billing shared his/her password to your account (containing your medical and financial identity) with someone not authorized to access your information?

HIPAA 52

HIPAA Compliance Electronic Medical Records Governance 52

Hall Render

OCTOBER 20, 2023

Peter’s Health clinic nurses vote to join Montana Nurses Association NEBRASKA Nebraska hospitals warn seniors that Medicare Advantage isn’t for everyone Hospitals say Nebraska patients denied care under Medicare Advantage Cardinal Health to reduce operations at Nebraska plant NEVADA E. We want to know.

COVID-19 Vaccine 40

COVID-19 Vaccine Nursing Homes COVID-19 Nurses 40

Hall Render

AUGUST 19, 2022

PruittHealth CEO: Nursing Home Operators Can’t Break Into Small Markets Without Government Support. UnitedHealth Group buys Medicare insurer in Texas. Collapse of private equity-backed Missouri hospitals mired employees in medical bills. Medical billing vendor data breach affects more than 942,000 patients.

COVID-19 40

COVID-19 Nursing Homes US Department of Health and Human Services Nurses 40

Hall Render

MARCH 8, 2024

NATIONAL 34.5% NATIONAL 34.5% NATIONAL 34.5%

Nursing Homes 40

Nursing Homes Nurses Hospitals COVID-19 40

Hall Render

MAY 19, 2023

SOUTH CAROLINA Grand Strand hospitals hope to see positive impact from Certificate of Need repeal McMaster signs South Carolina’s certificate of need repeal Newly-passed bill allows MUSC to move forward with delayed Nexton Hospital build Prisma Health records $31.7M million to strengthen healthcare in WV Top Doctors Named Across W.Va.

Nurses 40

Nurses COVID-19 Hospitals Nursing Homes 40

Hall Render

MARCH 3, 2023

million for youth mental health care KENTUCKY Pike County nursing home officials release statement following loss of Medicare agreement Three Humana executives drop $11.2M

Nursing Homes 40

Nursing Homes COVID-19 Nurses Hospitals 40