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Don’t bill the patient if you missed the required pre-auth, pre-cert

07/28/2014

If a patient is seen in our clinic, and we don’t know that a pre-authorization or pre-certification is required because he didn’t give us his correct insurance information, would the balance be the patient’s responsibility if the claim is denied?

For screenings at skilled nursing facilities, bill the SNF or sublease

07/28/2014

by: Roy Edroso

A physician has been offered the use of a treatment room in the nursing home for “skin cancer evaluation and treatment.” The physician wants to know how he should bill Medicare for those sessions, including the place of service (POS).

How to handle patients who record encounters with your physicians

07/28/2014

by: Marla Durben Hirsch

It’s become increasingly easy and popular for patients to use their cell phones to record their office visits, post-procedure instructions and other physician encounters. But the new custom can raise compliance issues in surprising ways — especially if the physician doesn’t know that he is being recorded.

Cash in on your private payers’ pay-for-performance financial incentives

07/28/2014

by: Ben Hartman

Take advantage of the financial rewards your private payers offer for providing high-quality care by following national quality guidelines. Start with simple steps instead of trying to match your program to each payer’s requirements.

Global-period change could hit dermatology, ophthalmology, orthopedics most

07/28/2014

The most commonly billed codes with 10- and 90-day global periods are billed most often by certain specialties that could take the brunt of a recently proposed change.

Proposed change to home health face-to-face rule could mean less work for docs

07/21/2014

by: Burt Schorr

Your practice may have to only provide a medical record — not have to have your physician write a narrative — to justify a patient’s eligibility for home health services.

Increase your billing success: Let billing staff be experts on payer policies

07/21/2014

by: Jennifer Clampet

Implement an approach to your medical claims process that allows your coders and billers to develop an expertise in dealing with specific payers and their policies to avoid unnecessary denials and lost reimbursements.

Avoid pitfalls by composing, enforcing proper HIPAA policies, procedures

07/21/2014

by: Roy Edroso

Don’t sustain a costly HIPAA violation just because you failed to revise a simple written document.

Maximize use of Open Payment dispute process before data goes public

07/21/2014

by: Roy Edroso

You now can track and dispute what manufacturers have reported about their financial relationships with your doctors before it goes public. You also can appoint a representative to handle the work for your doctors, but if you want to change the data, you have to get the manufacturer who gave the payments to agree.

Embrace trend of patient use of technology to improve patient care

07/21/2014

by: Scott Kraft

Patients are increasingly turning to technology to monitor their own health, compile health data including vital signs and cholesterol levels and even administer their own strep tests. Providers would be wise to embrace the technologies as well and give patient-oriented care based on the advanced knowledge of each patient.

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