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Latest Updates on Medical Billing

Latest Updates on Medical Billing

The DMEPOS fee schedule has been updated by the CMS for 2019 and several new codes have been added to the HCPCS file. For instance, from 1st January 2019, DMEPOS fee schedule file includes fees for three home infusion G-codes – G0068, G0069 and G-0070. For other new CY2019 codes, the fee schedule amounts will be established under the July 2019 DMEPOS fee schedule update. Reportedly, the DME MAC will establish local fee schedule amounts

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The DME Billing market in the US is growing and it is expected to reach $60.2 billion by 2020. Even though the competitive bidding under Medicare and other regulations are making DME sales challenging, the demand for DME continues to grow every year. DME providers need to understand the industry really well, particularly around billing and reimbursements. For instance, if they have submitted the claim and it gets denied, they will lose out on that

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According to a survey by AAFP (American Academy of Family Physicians), denials are a frequent occurrence accounting for between 5-10% of hospital claims. Industry experts believe that in order to improve revenue flow, it is very important for providers to keep this number close to 5%. And in order to achieve this, they need to have a robust denial management process in place. Why denials continue to be a challenge? You will be surprised to

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An important question that several practices across the US don’t have a clear answer to is- “Why aren’t we collecting more of our A/R?” Lack of efficient revenue cycle and a process for monitoring A/R days are two main reasons why they fail to maintain good finances. Where practices lack? Most A/R managers fail at monitoring the performance of their A/R efforts and solving potential collection problems. Most practices struggling with A/R lack a robust

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Did you know, in 2015, Medicare lost $3.2 billion due to improper medical billing for DME claims? Even today, DME suppliers have to encounter heightened scrutiny of their claims for obtaining Medicare payments. In order to receive timely payments, it has become imperative for DME suppliers to demonstrate medical necessity of the durable medical equipment. Without securing and retaining the right documentation of medical necessity, obtaining Medicare payments can become a nightmare for those involved

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In order to survive 2019 and get timely payments, DME providers will have to primarily focus on error-free coding. DME coding intricacies are deep rooted in HCPCS (Healthcare Common Procedure Coding System) Level II codes and policies by Medicare. Providers will have to hire DME coders who are experts at assigning the right HCPCS Level II codes for timely and error-free billing. They will have to have a good understanding of Medicare policies related to

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Ambulatory surgical centres in the USA have not shown any significant growth in the past few years. Many of them either closed down or merged with bigger medical groups due to revenue issues. According to Provista Report of ASC Survey Findings, reimbursement is the biggest challenge faced by ASCs across the country along with management of days in A/R. 2019 will demand effective revenue cycle management for ambulatory surgery centres. This is because even after

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As per the U.S. Physician Employment Report, conducted by Doximity, physician employment opportunities increased by 7% in 2018. In 2017, this employment growth rate was 5.1%. As per another survey conducted by Physicians Foundation in 2017, more that 57% of physicians were employed at hospitals and medical groups, whereas only 32% were independent practice owners. Results from these surveys are a clear indication that physicians are opting hospital employment over private practices. Here are some

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2018 witnessed many changes, from rise of automation to increase in medical billing outsourcing. With the advent of 2019, it is a critical time for every provider to look out for latest changes in medical billing services. For healthcare practices, efficient revenue cycle management is the most important element of success and in order to achieve a seamless cashflow, practices will have to focus on having systematised medical billing. Following are few of the key

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For many healthcare providers, maintaining optimal cash flow and improving payment collection has become a challenge. They are losing money due to lack of rigorous and regular monitoring of their revenue cycles. Mentioned-below are six key revenue cycle performance metrics that should be discussed and analysed monthly by practices: Number of days in A/R. This is one of the most important metrics that helps in understanding the efficiency of the current revenue cycle. Calculating the

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