It seems as if  commercial payers are doing all they can to keep from reimbursing providers in a timely manner. According to a recent  report by Crowe , 31% of claims submitted to commercial payers in the first quarter of 2023 were not paid for at least three months, as compared with 12% of Medicare claims. Medical necessity denials have risen as well. During the same timeframe, inpatient claims denied due to medical necessity issues were 3.2% among commercial payers and 0.2% for Medicare. Commercial payers have 12 times the denial rate that Medicare has based on requests for more information, according to Crowe. The following are three key interventions providers can implement now to help them do just that. Key intervention 1 Negotiation and contract m anagement optimization Hospitals can work with hundreds of payers, each with its own contract terms, processes,and ever-changing requirements. Managing these contracts can be challenging for resource-strapped organizatio...

  © yavdat - stock.adobe.com Simply  stated , “[p]ursuant to section 205 of the Health Insurance Portability and Accountability Act of 1996 ( HIPAA ), Public Law 104–101, codified at section 1128D of the Social Security Act (Act), the Secretary must publish advisory opinions regarding the application of the Federal anti-kickback statute and the safe harbor provisions, as well as certain other administrative sanction authorities, to parties’ proposed or existing arrangements.” For those unfamiliar with U.S. Department of Human of Health and Human Services Office of the Inspector General’s (HHS OIG) advisory opinions, an advisory opinion may be requested with regards to the following: What constitutes prohibited remuneration under the Federal anti-kickback statute; Whether an arrangement or proposed arrangement satisfies the criteria in section 1128B(b)(3) of the Act, or established by regulation ( i.e. , safe harbors), for activities which do not result in prohibited remunerati...

  Accurate and efficient medical billing for any healthcare facility is a must for a great revenue stream and undisrupted cash flow. Even when you are hiring professionals from a reputable  medical billing company  to handle all your billing-related matters, you still may have certain doubts in your mind about whether outsourcing is right or not. Furthermore, other common myths related to medical billing itself may also be causing your healthcare facility to be behind your competitors as well as financially. Of course, you want to provide the best patient care, and it also involves smooth billing. In this article, we’ll share the common myths about medical billing and the facts to help you run your healthcare practice successfully. Myth #1: Only Medical Knowledge and Materials Is Required While it’s true that a medical billing team should have a solid knowledge of medical terminologies and common diseases to perform their best at work. Nevertheless, you need to know more ...

Medical billing services can alleviate the burden of coding claims and chasing collections. The best services offer certified medical coders and billers who can create, submit and follow up on claims to ensure they get paid quickly and in full. Most medical billing services also offer rejection and denial management services, employing a team to revise and resubmit claims that clearinghouses and payers refuse.

  A recent survey of medical billing companies shows a positive outlook on revenue cycle outsourcing, with many seeing payment collection as an opportunity. Nearly two-thirds of medical billing companies have a rising positive outlook about the current state of the revenue cycle outsourcing industry, according to a recent  survey  from Tebra. The practice growth technology company recently surveyed 277 medical billing company owners, leaders, and team members serving independent practices and clinics in the US. The majority of respondents belonged to companies that serve less than ten practices and clinics. Medical billers are optimistic about the future of the industry despite increased competition, healthcare consolidation, and other unfavorable macro forces. About 43 percent—up from 27 percent in 2018—reported outsourcing of medical billing as a significant opportunity to leverage technology to optimize services, reduce repetitive tasks, and boost revenue.

  One year ago, the United States marked a turning point for health care cost transparency with a new law aimed at helping Americans avoid unnecessary, unexpected medical debt. As of Jan. 1, 2022, health care providers and insurers are no longer allowed to sideswipe privately insured people with bills for out-of-network services. Experts say the bipartisan No Surprises Act was a rare victory for patients and the public against exploitative health care costs, but that challenges remain. In 2019, Republicans and Democrats in Congress worked together to craft legislation that ultimately became the No Surprises Act. The  law protects people  in group and individual health insurance plans from receiving unexpected bills from out-of-network providers who cared for them at in-network facilities – a system already in place for Medicaid and Medicare patients. An independent dispute resolution process now allows insurance companies and providers to figure out coverage and costs aft...

  As more primary care providers integrate behavioral health services into their practice, EHR platforms must evolve to meet the needs of healthcare providers and their patients. The U.S. is suffering from a mental healthcare crisis. According to the   National Alliance on Mental Illness  (NAMI), one in five adults in the U.S. experience a mental health disorder each year, but less than half (47.2%) received treatment in 2021. These data points become even more devastating when you consider that suicide is the second leading cause of death among children age 10- to 14-years-old, with one in six kids age 6- to 17-years-old suffering from a mental health disorder every year. The silver lining here, if there is one, is that deep-rooted stigmas attached to behavioral healthcare are finally losing their crushing grip on our patient populations as more people openly discuss mental health issues. Another step in the right direction: two years after the pandemic resulted in alarm...