As healthcare coding evolved from ICD-9 to ICD-10, understanding the updated codes for neurological conditions has become crucial for accurate billing and documentation. Healthcare practices, especially those focusing on neurology, must ensure they are coding correctly to optimize reimbursements and maintain compliance. This guide provides a brief overview of the ICD-9 to ICD-10 conversions for […]
In New Mexico, Behavioral Health (BH) agencies play a vital role in delivering specialized treatment and training to providers seeking independent licensure. These agencies provide an array of services, from comprehensive community support to opioid treatment programs. To effectively manage the complexities of Revenue Cycle Management (RCM) and credentialing, healthcare practices must stay compliant with […]
In many healthcare practices, medical billing is often an overlooked aspect, treated as a tedious task rather than a critical function. Billers are frequently left to work in isolation, away from the main practice areas, despite being essential to the organization’s cash flow. However, the efficiency and accuracy of these billers directly impact revenue, and […]
Medicare’s Targeted Probe and Educate (TPE) audits are designed to identify and correct billing errors in a more “warm and fuzzy” manner compared to traditional audits. While the process might seem intimidating, understanding the TPE audit’s structure and requirements can help healthcare practices better prepare and respond. This comprehensive guide will break down the TPE […]
Payer agreements are contractual arrangements between healthcare providers and payers, ensuring that providers receive proper reimbursement for the care they provide to patients covered under specific payers. These contracts are essential for several reasons, benefiting providers, payers, and patients alike. Ensuring Timely Reimbursement One of the primary advantages of payer agreements is the assurance of […]
In 2021, 60% of healthcare payments were tied to value and quality-based care, while 40% originated from fee-for-service models. These two systems are often viewed as polar opposites in the healthcare industry. While the adoption of value-based care is increasing, fee-for-service remains a significant component of the healthcare payment landscape. It’s crucial to understand both […]
In today’s healthcare landscape, managing the revenue cycle is crucial for the sustainability of any medical organization. The financial health of a practice hinges on effective patient payment collections. If your practice is diligent in sending out statements but faces challenges in collecting payments, it will inevitably affect your bottom line. To ensure the financial […]
Starting a new medical practice is a challenging endeavor. Many new practices fail due to a variety of reasons. Here are the top five reasons why new practices fail, accompanied by real-life examples: 1. Doctor’s Underestimate the Work Involved A primary care practice in Savannah, GA underestimated the amount of work it takes to customize […]
Today, we’re going to delve into a topic that’s crucial for healthcare providers – documenting medical necessity. It’s a complex subject, but don’t worry, we’ll break it down together. Understanding Medical Necessity First things first, what is medical necessity? It’s a term that’s often interpreted differently by various payers, but most definitions incorporate the idea […]
Over the years, private practices, especially those with 7 or less providers, have struggled with which compensation model to use when contracting new Physicians and Physician Extenders. The very popular model of Straight Salary, which has commonly been used since the 1990’s, is proving not to be the best model for either the practice or the provider. Straight Salary models, and those that […]
