False Claims Act in Healthcare The False Claims Act (FCA) in healthcare (also called the ‘Lincoln Law’), is a federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal government’s primary litigation tool in combating fraud against the government. The federal False Claims Act makes it illegal to: […]
CPT codes for Evaluation & Management (E&M) services are principally included in the CPT code range 99202-99499. The codes describe the site of service (e.g., office, hospital, home, nursing facility, emergency department, critical care), the type of service (e.g., new or initial encounter, follow-up or subsequent encounter), and various miscellaneous services (e.g., prolonged physician service, […]
Medical practices sometimes equate improper payments with medical billing fraud. Improper payments could be unintentional where your received payment even after not meeting program requirements. While medical billing frauds are intentional where practices might through up-coding and unbundling try to receive more insurance reimbursements than allowed. For differentiating between improper payments and medical billing fraud, let’s […]
Strengthening Affordable Care Act (ACA) Recently, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality healthcare options for millions of consumers. This proposed rule would increase […]
Significance of Patient Experience There is no question that patient experience is a huge factor when it comes to the success of your practice. In case of negative patient experience, their word-of-mouth can adversely impact future patients as well as their willingness to pay bills in a timely manner. The patient experience begins as soon […]
Basics of No Surprises Act The No Surprises Act went into effect on January 1, 2022. This Act is aimed at reducing ‘surprise bills’ to patients in the context of services provided at hospitals and ambulatory surgical centers and includes requirements for hospitals and ambulatory surgical centers, as well as physicians providing services at such […]
Initial Preventive Physical Examination (IPPE) The initial preventive physical examination (IPPE) is a preventive visit also known as a ‘Welcome to Medicare Preventive Visit’. Medicare pays for one IPPE per beneficiary per lifetime for beneficiaries within the first 12 months of the effective date of the beneficiary’s first Part B coverage period. The IPPE may […]
What Is Claim Scrubbing? Claim scrubbing is a method of reviewing claims before a medical practice submits them to an insurance carrier. Claim scrubbing removes all the errors that might lead to claim denials. In the claim scrubbing process, the billing team checks the correctness of the Current Procedural Terminology (CPT) codes in your claims. This […]
Patients Love Telehealth Healthcare providers and patients used to see medical care as something best done in-person. But the COVID-19 pandemic changed everything including a massive transition to virtual care. According to McKinsey Consumer Health Insights Survey, patients still prefer the convenience of digital engagement and virtual care options. This patient preference is an opportunity […]
Need of Online Presence In the current era of digitalization where mobile phones are no longer used only for calling, your patients are using every possible online channel to find information about your practice. Earlier, healthcare practices used to get incoming calls or voicemails filled with questions about the practice. Now patients might have the […]
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