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The Tennessee Medical Association, which represents thousands of Tennessee physicians is pushing for a new state law that would add much needed predictability in contracts between health plans and health care providers. It is our top legislative priority this session and, if passed, will be the first law of its…
Know What Role You Play In Your Providers Success which is specific to DME providers. Anecdotal evidence shows that up to 70% of claims submitted by a medical provider have either missing or incomplete information. These errors could be minor (think name mismatch) or more troublesome like missing Social Security…
Are you worried about outsource Medical Billing? Medical billing is a tedious job and it requires a lot of time and efforts to get paid from an insurance company, however outsourcing it to a professional medical billing services provider firm can significantly reduce your burden and save much of your…
New prepayment audits strike fear in Medicare providers. Many medical practices accept patients who are covered by Medicare or Medicaid. If you’re one of these practices, you need to know about some updates in these agencies’ auditing processes that can seriously affect your patients and your medical practice. In 2017,…
As a successful medical practitioner, If you want your medical practice to keep growing, you need to identify any problems that are preventing that growth and address those issues. That’s what a medical billing assessment is for. What Is a Medical Billing Assessment? A medical billing assessment includes a comprehensive audit that focuses…
A new CMS proposed rule would revise the national competitive bidding program with a blend of smaller, short-term tweaks and larger, more structural changes; provides longer relief for rural and non-competitive bid area providers; and addresses oxygen reimbursement. The Centers for Medicare & Medicaid Services took steps toward changing Medicare’s…
Dual Eligible Beneficiaries may face special obstacles when they try to access services, such as durable medical equipment, that is covered to varying degrees by both Medicare and Medicaid. The Integrated Care Resource Center recently released a briefing titled “Facilitating Access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in…
How To Make Your CLAIM AUDIT Look Like A Million Bucks? HME businesses face increasing numbers of pre- and post-payment audits, which can be very stressful and costly events. Without a sound strategy for maintaining accurate and retrievable documentation, an audit request can disrupt operations and put your organization at…
Common Documentation Errors Identified by CERT & RACS. The Centers for Medicare & Medicaid Services calculates the Medicare Fee-for-Service (FFS) improper payment rate through the CERT program. Each year, CERT evaluates a statistically valid stratified random sample of claims to determine if they were paid properly under Medicare coverage, coding, and…
The Centre for Medicare and Medicaid Services offers extensive and detailed DME Medicare documentation guidelines in general, as well as other guidelines for documentation that can be found in Local Coverage Determinations and National Coverage Determinations. Durable Medical Equipment billing continues to scrutinized by Medicare and other Commercial Carriers, so…
