You are likely to leave money on the table in the form of lower rates for patients with ACA exchange plans when you don’t proactively act on contract amendments sent by your existing health payers, experts says.

Before your practice reduces staff to save money, take a detailed look around — ideas for trimming unnecessary costs may be hiding in plain sight.

Private payers have noticed the extra scrutiny your Medicare fee-for-service claims face from different auditors, and they’ve been getting in the act as well – launching aggressive audits, claims reviews and denials management strategies hitting your bottom line.

If you plan to appeal denied claims, it helps to know (using CMS data) what your chances are. 

The lackluster history associated with new patient E/Ms — particularly when trying to bill the higher-level services — often stands in the way of getting paid, experts tell Part B News.

EHR vendors are rolling out financial analysis tools that pull data from your electronic health records and practice management systems. While this is a promising development, it may not be time to stop using your Excel spreadsheets yet.

Providers already know their financial relationships with pharmaceutical and medical device manufacturers will soon become public via an HHS website thanks to the new Sunshine Act. But failing to tell patients about those relationships up front may lead to hefty fines for violating state consumer protection laws.

If your practice is affiliated with a hospital or health system, you may be using the wrong place of service (POS) code on your claims — just as CMS is cracking down.

In perhaps another sign of the growth in services furnished by non-physician practitioners, the SSA is being asked to give equal weight to the medical findings of NPPs when determining whether a person is eligible for Social Security disability payments.

Will Medicare pay for the home INR testing with code G0250 (M.D. INR test review management) and an E/M service when both are billed on the same date of service?