Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Front-Desk Collections in 2023: Copays, Deductibles and Newly Uninsured Patients
Cost sharing is back on COVID-related visits, deductibles keep rising, and some of your patients are uninsured for the first time in three years. Here is how to estimate what is owed before the visit, the script that works at the desk, a card-on-file policy that holds up, and the statement cycle that follows.
Eligibility Checks After the PHE: Rechecking Medicaid Coverage at Every Visit
Six weeks into the Medicaid unwinding, the first states have posted termination numbers and most people losing coverage are losing it for paperwork reasons. Here is how the 271 response shows what changed, the pre-visit and day-of checks that catch it, and what to do with claims for patients who are later reinstated.
Telehealth Billing After the PHE Ended May 11, 2023: What Continues, What Ended
The COVID-19 public health emergency ended yesterday after more than three years. Most Medicare telehealth flexibilities continue through December 31, 2024 under the Consolidated Appropriations Act, 2023, but several things changed on May 11. Here is the sorted list and how to bill telehealth for the rest of 2023.
Enrolling a Provider Who Starts July 1: Working Backward From the Start Date
Residency ends June 30 and new physicians start July 1, which leaves about ten weeks from now to get them enrolled. Here is the dependency chain from license to payer effective date, what each payer does about retroactive billing, and how to schedule the first weeks so the gap costs as little as possible.
HIPAA Reproductive Health Privacy Proposal: What Practices Should Review Now
On April 12, 2023, HHS proposed HIPAA Privacy Rule changes limiting how reproductive health information can be disclosed for investigations. Nothing is final, but the proposal points at workflows every practice has: subpoenas, law enforcement requests and record releases. Here is what to review now.
ICD-10-CM April 2023 Update: 42 New Codes for Social Needs and Financial Abuse
The April 1, 2023 ICD-10-CM update added 42 diagnosis codes, mostly for health-related social needs and for financial abuse, and deleted seven. Here is what was added, why the Z codes matter more than they pay, and the four systems to update before claims start rejecting.
UnitedHealthcare's 20% Prior Authorization Cut: What Changes for Practices
UnitedHealthcare says it will drop prior authorization for about a fifth of its procedure volume starting in Q3 2023, days after an AMA survey found 94% of physicians see care delayed by authorizations. Here is what was announced, what CMS finalized the same week, and how to run the desk regardless.
Medicaid Continuous Enrollment Ends March 31: What Practices Should Do in April
Three years of guaranteed Medicaid coverage end on March 31, 2023, and states can begin disenrolling people on April 1. Millions will lose coverage, many for paperwork reasons. Here is the timeline, the denials to expect, and the front-desk and billing changes to make before the first terminations land.
Modifier 25: When the Office Visit Is Separately Billable and When It Is Not
Modifier 25 is the most used and most audited modifier in office-based medicine. Here is the test we apply, five worked examples, the denial codes it produces when it is wrong, and how to build a quarterly self-audit before a payer does it for you.
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