Healthcare IT Today

FEBRUARY 22, 2023

There’s widespread consensus that payments to Medicare Advantage Organizations (MAOs) are a mess. These programs, which care for more than 30 million of the nearly 64 million Medicare enrollees , operate on the cutting edge of health care and suffer serious problems in data collection and billing.

Medicare 88

Medicare Medicare Overpayments Overpayment 88

Medisys Compliance

APRIL 8, 2022

In this article, we briefly discussed these Medicare telehealth billing guidelines. CMS has finalized certain services added to the Medicare telehealth services list will remain on the list through December 31, 2023.This To know more about our Telehealth billing services, contact us at info@medisysdata.com/ 302-261-9187.

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Medicare Medicare Medical Billing Outsourcing Medical Billing 59

Healthcare IT Today

SEPTEMBER 24, 2023

Medicare Advantage costs are 12% lower than similar beneficiaries covered under fee-for-service Medicare, according to research from Inovalon and Harvard Medical School. Nearly three in four (72%) patients say affordability is the biggest challenge to paying larger healthcare bills , according to a survey from Cedar.

Medical Billing 111

Medical Billing Department of Veterans Affairs Medicare Medicare 111

Medisys Compliance

APRIL 11, 2024

Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs) can now directly bill Medicare for services they furnish and diagnose. Eligibility and Covered Services To directly bill Medicare, you must meet specific eligibility criteria. The next step involves enrolling as a Medicare provider.

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Medicare Medicare Medical Billing Outsourcing Medical Billing 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

MARCH 14, 2023

Wound care is provided in various healthcare settings like inpatient hospital, outpatient clinics, long-term care facilities, home health settings, hospice and skilled nursing facilities. For example, patients who require ongoing wound care but do not need to be hospitalized can receive treatment in outpatient clinics.

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Payment Systems Medical Billing Medicare Medicare 52

HIT Consultant

JUNE 12, 2022

According to the Journal of the American Medical Association , one in five insured adults had a surprise medical bill from an out-of-network provider. Overall, two-thirds of adults are worried about their ability to afford unexpected medical bills. Surprise Billing Causes. Two-thirds of U.S.

Medical Billing 98

Medical Billing Medicare Medicare Health Insurance 98

Medisys Compliance

APRIL 26, 2024

office, hospital outpatient department). Common POS codes for primary care include 11: Office; 20: Outpatient hospital. Essential Considerations for Accurate Outpatient Billing Accurate Documentation: Detailed and clear physician documentation is vital for accurate coding.

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Medical Billing Medical Billing Outsourcing Medical Billing Services Patient Satisfaction 59

Healthcare IT Today

AUGUST 6, 2023

News and Research Five in six (83%) of hospitals are collecting SDoH data , according to the latest ONC Data Brief, with 74% using structured, electronic screening tools. Another 60% of hospitals are receiving SDoH data from outside sources, primarily from HIE entities.

Hospitals 85

Hospitals Nurses Medical Billing Ransomware 85

Medisys Compliance

APRIL 20, 2022

We shared billing update for free COVID-19 tests and second free booster dose in detail in this article. Medicare to Cover Over-the-Counter COVID-19 Tests. People with Medicare can get up to eight tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency.

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COVID-19 COVID-19 Vaccine Medical Billing Medicare 52

Healthcare IT Today

FEBRUARY 23, 2023

Streamline the billing process The right RCM partner will help providers optimize revenue by creating faster, easier processes to identify insurance coverage. As Medicare Beneficiary Identifiers (MBIs) only relate to Medicare coverage, providers need tools that will go beyond MBIs and caps from payer searches.

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Medical Billing Patient Satisfaction Medicare Medicare 128

Medisys Compliance

JUNE 16, 2022

Medicare’s 3-day (or 1-day) payment window applies to outpatient services that hospitals and hospital wholly owned or wholly operated Part B entities furnish to Medicare beneficiaries. However, if a third organization owns or operates both the hospital and the entity, then the payment window provision doesn’t apply.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Hospitals Medicare 52

Medisys Compliance

JUNE 28, 2022

Medicare Coverage for Continuous Glucose Monitors (CGMs). On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) published a final rule in the Federal Register that addressed the classification and payment of continuous glucose monitors (CGMs) under the Medicare Part B benefit for durable medical equipment (DME).

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Medicare Medicare 52

Medisys Compliance

MARCH 26, 2024

However, navigating the complexities of Holter monitor billing can be a time-consuming and error-prone process. 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.

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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

FEBRUARY 5, 2024

Introduction The healthcare landscape is ever-evolving, and with it, the way medical services are delivered and billed. Ambulatory Surgery Centers (ASCs) have emerged as popular settings for various outpatient procedures, offering convenience and cost-effectiveness compared to traditional hospital stays.

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Medical Billing Outsourcing Medical Billing Medicaid Medicaid 59

Health Populi

OCTOBER 28, 2019

84% of Americans told the Foundation that they were concerned about how much health care costs will affect them in the future, with 42% of patients saying they couldn’t afford to pay over $500 for an unexpected medical bill. Hospital costs contribute to rising medical costs to 49% of health consumers.

Hospitals 54

Hospitals Prescription Drug Pricing Pharmaceutical Industry Medical Billing 54

Medisys Compliance

MARCH 10, 2022

For example, PCM could be appropriate for a patient with uncontrolled diabetes or uncontrolled hypertension or a high-risk patient with severe asthma who has frequent hospital readmissions. Many practices are already doing this work to take care of these patients, they just need to capture the right information so they can bill for it.

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Medical Billing Outsourcing Medical Billing Medicare Medicare 52

Medisys Compliance

MAY 30, 2022

These regulations are the basis for Medicare guidelines. There is no specific Medicare-approved form for PCS. Regardless of the form you choose to use, the information on the form must comply with Medicare guidelines. Note: Medicare requires that services provided/ordered be authenticated by the author.

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Medical Billing Outsourcing Medical Billing Medicare Medicare 52

HIT Consultant

JUNE 16, 2022

The importance of the No Surprises Act (NSA) cannot be overstated, as surprise medical bills have long been burdensome for patients in the U.S. consumers have received an unexpectedly large medical bills. The purpose of the No Surprises Act is to prevent surprise out-of-network bills, often for emergency services.

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Medical Billing Compliance Health Insurance Hospitals 52

Health Populi

OCTOBER 15, 2019

These study respondents had also visited a doctor or hospital and paid a medical bill in the past year. One-third of these patients had a health care bill go to collections in the past year, according to Cedar’s 2019 U.S. 50% want clearer, easier-to-understand medical bills.

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Medical Billing Doctors Medicare Medicare 94

AIHC

JANUARY 5, 2022

Starting January 1, 2022, the No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers at in-network facilities, and services from out-of-network air ambulance service providers.

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Medical Billing Health Insurance Hospitals Medicare 52

Medisys Compliance

FEBRUARY 20, 2022

Note that, incident-to services are only applicable to Medicare. Incident-to services are only applicable for charges billed to a Medicare contractor. You will have to verify with each private insurance carrier on how to bill for services performed by an NPP. Billing Requirements for ‘Incident-to’ Services.

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Medical Billing Outsourcing Medical Billing Medicare Medicare 52

Medisys Compliance

MARCH 19, 2024

Additional Billing Considerations In addition to mastering the core billing codes, providers must also navigate supplementary elements integral to accurate billing: Place of Service (POS) Codes: Indicating the treatment setting (e.g., office, hospital outpatient), POS codes play a pivotal role in determining reimbursement rates.

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Medical Billing Outsourcing Medical Billing Health Services Administration Public Health 59

Compliancy Group

FEBRUARY 7, 2024

This is because the Centers for Medicare & Medicaid Services (CMS) have ramped up their efforts to identify organizations that have improperly billed for medical services. The Centers for Medicare and Medicaid Services (CMS) created UPIC audits to identify and stop fraud and abuse in Medicare and Medicaid.

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Fraud Compliance Medicare Medicare 52

Medisys Compliance

APRIL 5, 2023

A nerve block injection involves injecting medication directly into the nerves to reduce inflammation and relieve pain. The injection is typically performed in an outpatient setting, such as a doctor’s office or a hospital. Is CPT 64625 Covered by Medicare? CPT code 64625 is covered by Medicare.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medical Billing Medicare Medicare 52

Healthcare IT Today

JUNE 29, 2023

Understanding ASCs Regulatory Changes and Their Billing Practices Outpatient surgery centers (ASCs) perform many surgical procedures outside of hospitals. However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. ASCs must also meet Medicare’s Conditions for Coverage.

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Compliance Medicare Medicare Medical Billing 52

Medisys Compliance

AUGUST 12, 2022

CMS recently introduced guideline changes to its Medicare reporting rules that impact physician assistant (PA) and nurse practitioner (NP) billing. Chapter 12 of the Medicare Claims Processing Manual no longer includes an office/clinic example. Reference: Medicare Claims Processing Manual Chapter 12.

Medical Billing Outsourcing 52

Medical Billing Outsourcing Medicare Medicare Nurses 52

Medisys Compliance

JUNE 20, 2023

Billing CPT 95250 and CPT 95251 is a crucial aspect of medical billing for healthcare providers who offer diabetes self-management education and training (DSMT). physician office, hospital outpatient department).

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Medical Billing Outsourcing Medical Billing Medicare Medicare 52

Jane Sarashon

FEBRUARY 4, 2024

Furthermore, health plan members now see themselves as medical bill payers, seeking value and consumer-level services for their health insurance premium investment. Patients and health plan members continue evolving into medical bill payers, with their homes and budgets baked into the concept.

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US Department of Health and Human Services Health Insurance Medicare Medicare 70

Jane Sarashon

FEBRUARY 27, 2024

In addition to highlighting the Patient’s Bill of Rights, NABIP’s keynotes and general sessions will speak to similar topics being brainstormed at VIVE this week — including mental health, maternal health, pharmacy and prescription drugs (pricing, PBMs), population health, and Medicare and Medicaid innovations.

ACA 113

ACA Prescription Drug Pricing Health Insurance Hospitals 113

Medisys Compliance

MARCH 31, 2023

Determine the Provider Type Ohio Medicaid has different provider types, including Individual practitioners, group practices, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Hospitals, and Home health agencies. When enrolling in Ohio Medicaid, providers must determine which of these provider types they fall under.

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Medicaid Medicaid Licensing Medical Billing Outsourcing 52

Hall Render

MAY 10, 2024

Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M Million CALIFORNIA California hospital dismisses CEO California physician pleads guilty to $2.5M million expansion ‘Very, very unusual.’

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

HIT Consultant

MARCH 22, 2023

Paul Ketchel, CEO of MDsave Over two years have passed since the hospital price transparency rule was enacted. The Centers for Medicare and Medicaid Services recently announced that in 2021, the nation spent $4.3 A recent study found only 16 percent of hospitals nationwide comply with price transparency guidelines.

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Patient Satisfaction Compliance Hospitals Health Insurance 97

Healthcare IT Today

OCTOBER 15, 2023

Partnerships Brightside Health is now offering telemental health access to Medicare and Medicaid beneficiaries through partnerships with payers such as Centene, Optum, and various Blues plans. KeyCare is partnering with Remission Medical to provide virtual rheumatology care. Intermountain Health chose ClearSense for data archiving.

Medical Billing 106

Medical Billing Medicaid Medicaid Hospitals 106

Hall Render

APRIL 19, 2024

to Study Treatments for Vascular Abnormalities Federal Appeals Court Hears Arguments on Nation’s First Ban on Gender-affirming Care for Minors Jason Demke Hired as COO at Mercy Hospital Fort Smit Pulaski Tech Awarded $5.7M

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Nursing Homes Nurses Hospitals Doctors 40

Kaiser Health News

MAY 31, 2022

So when her primary care doctor suggested she be screened for colorectal cancer in September, Melville dutifully prepped for her colonoscopy and went to New London Hospital’s outpatient department for the zero-cost procedure. Medical Service: A screening colonoscopy, including removal of a benign polyp.

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ACA Doctors Medical Billing Hospitals 106