by admin | Dec 30, 2019 | Billing Terms, Codes, Denials Management, Patient Billing
Changes coming in 2021 2020 looks to be a transition year on the payment front, as many programs and changes expected to go into effect this year have been delayed until 2021. These include new CMS-created primary care models and a streamlining of evaluation and...
by admin | Sep 4, 2018 | Denials, Denials Management, Health Care Finance, Hospital Revenue Cycle, Medical Billing, Revenue Cycle KPI's
Two metrics important to the discussion of creating claims most likely to be immediately reimbursable are Clean Claim Rate (CCR) and First Pass Rate (FPR). Though sometimes confused for one another, these are separate statistics, each worthy of optimization....
by admin | Jul 10, 2017 | Accronyms, Acronyms, BCBS, Billing Systems, Billing Terms, Insurance Claims, Patient Billing
Blue Cross Blue Shield Enhanced Ambulatory Patient Grouping (EAPG) methodology for calculating reimbursement for outpatient procedures http://www.okoha.com/OHA/Hotline/2015/April15/Taking_charge_of_the_EAPG__Improve_your_negotiations_with_BCBS.aspx Share...
by admin | Mar 15, 2017 | Health Care Finance, Insurance Claims, Learning, Medicare, Medicare Terms
https://qpp.cms.gov/ Share...
by admin | Dec 12, 2016 | Denials, Denials Management, Medical Necessity, Medical Necessity
Preventing Medical Necessity Denials KAREN HOPPE Although all hospitals must comply with a Medicare requirement that services provided to beneficiaries are reasonable and medically necessary for treatment and diagnosis, the criteria may be inconsistent among...
by admin | Sep 2, 2014 | BCBS, Insurance Claims, Medical Billing
Lots of great information to research BCBS claims Share...
