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 management level-of-care coding. CMS announced in October its newest alternative […]
Clean Claim Rate (CCR) and First Pass Rate (FPR)
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. HFMA identifies the value of CCR as an indicator of the quality of data collected and reported. […]
EAPG
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
Link to Medicare Quality Payment Program home page
https://qpp.cms.gov/
Preventing Medical Necessity Denials
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 the agencies setting them. The Centers for Medicare & Medicaid Services (CMS) created policies that dictate the criteria that […]
Blue Cross Blue Shield Directory
Lots of great information to research BCBS claims
CMS Clarifies Insurance Assistance Rules
Feb. 14—Healthcare foundations can pay for coverage by insurance plans offered on new government-run marketplaces, according to recent federal guidance. The 2014 launch of health insurance marketplaces, which were created by the Affordable Care Act, has increased the interest of hospitals and health systems in helping their patients afford either the premiums or out-of-pocket costs […]
Clinical Trial Billing Seminar
Clinical Trial Billing Seminar Clinical Trial Billing – Building a Compliant Process that Works! Why Should You Attend: Beginning in 2000, with the National Coverage Decision (now “Clinical Trials Policy” or CTP), Medicare covers routine costs for Medicare participants in clinical trials. Though designed to protect taxpayer’s funds from fraud and abuse, the rules and […]
Don’t give up on dead claims
Read this report before giving-up on “dead” claims Use ERISA protections to your advantage, make insurers follow the law The Employee Retirement Income Security Act of 1974 (ERISA) requires health insurers to respond to claims in a timely manner. Failure to do so can mean the claim is eligible for immediate payment, explains Richard […]
NPI Directory
Physicians NPI Directory Use this link to verify the NPI on your claims
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