This is the first in a series of articles reviewing billing reports—what they tell you, why you need them, and why you must look at them regularly. Many providers believe
When an insurance claim is reduced, denied, bundled, or assigned to the patient, the explanation is usually found in the adjustment codes on the Explanation of Benefits, or EOB, and
I was recently asked by a provider, who was involved in an audit, whether she may have been flagged because her fees were “too high.” When I asked how she
-Kevin Barrett (MedClaim Alliance) Not every overpayment demand is what it claims to be. Some are legitimate. If there’s a clear duplicate payment or an obvious billing error, the right
In New Jersey and surrounding areas, Aetna offered a special Medicare Advantage plan to retired state employees and other retiree groups. This plan is called a Medicare Advantage PPO ESA plan.
Healthcare is changing fast, and acupuncturists need to pay attention. Two of the biggest developments I am watching right now are Value-Based Care and increased reimbursement audits. Both point to the same conclusion:
Most providers who bill insurance also offer some type of prompt-pay (time-of-service) discount. That’s allowed, and it makes sense—it reflects the real costs the office avoids when it doesn’t have
This builds on my other article about prompt-pay discounts and sliding scales—because this is where a lot of providers unintentionally get themselves into trouble. First, let’s clear up some common
Beginning in early March, acupuncturists—primarily on the East Coast—began reporting recoupments involving patients with Medicare Advantage coverage. Below is a summary of the known facts at this time: In practical
The typical reimbursement for medical providers is called a Fee-for-Service model this is where providers are paid for the services they provide, with no real oversight as to how the
Between 2021 and 2023, health insurance companies issued more than 49 million claim denials annually. But here’s what made regulators sit up and notice: Less than 0.2 percent of patients
Financial Policies When was the last time you looked at your financial policy? Do you even have one? Financial policies allow for patient engagement. If patients are aware of and
