Emergency services and self-pay patients- something that emergency service providers do not like to hear used in conjunction with one another. But unfortunately, due to the Emergency Medical Treatment and Labor Act enacted in 1986 and the ever rising cost of medical care and unemployment rates in the US, this is a trend that continues to rise. Do not let this rising trend give you anxiety when it comes to reimbursement.

As healthcare keeps evolving, from virtual visits to AI intelligence, soon healthcare may be portable and so small you could carry it with you in your pocket. That seemed like a wonderful idea to Chang Hun Lee. At the age of 16, Chang was diagnosed as pre-diabetic along with being obese. This was a scare for Chang, pushing himself to get back on track before it was too late, he’s now a senior at University of Illinois pursing business.

                  Knowing how to best handle a denied claim is essential for correcting a situation and figuring out how to obtain the payment anyway. Unfortunately, denials management is a neglected area of the industry. Most people avoid it because it requires such specialized knowledge of the procedures as well as some intensive labor of talking to different people and filling out numerous forms. Below are some tips in regards to avoiding denials.

The healthcare industry is often compared to the technology and retail industries, where the bottom line is exclusively tied to a consumer’s choice. Although it is obvious how opposite healthcare is from any other industry. A consumer buys something from Amazon or hails a ride from Lyft primarily because they want to, not because they have to. In healthcare, patients are not typically getting medical services by choice. Instead, they enter the industry when they are sick or in need of medical help.

On November 28^th 2018 Seattle e-commerce and technology giant unveiled what it calls Amazon Comprehend Medical, which the company says could help hospitals, clinics, and other healthcare organizations process patient information more quickly to glean new insights and, ideally, improve care by using Amazon’s software tools. Amazon has displayed an aspiring layout for the product. Despite the fact that the company has proven itself to be very skilled at building massive businesses in multiple sectors the new medical software presents a different kind of challenge due to the complexities of the healthcare industry today.

-New CPT add on codes allow providers to bill the following in addition to tumor removal procedures:

                  -20932-osteoarticular

                  -22093-hemicortical (partial) intercalary

                  -20934-complete intercalary

It is the time of year again that can cause mass chaos in medical practices, hospitals, and medical billing offices-the dreaded updates to ICD-10 guidelines and codes. Every year, the new guidelines become effective October 1 and are valid thru September 30. Staying on top of these changes and updates will in turn benefit all aspects of the billing cycle from educating providers to ensuring reimbursement is not affected. There have been updates/additions to the codes as well as changes to some of the guidelines. Below is a list of a few of the changes and a short description of the change.

Running a successful medical practice involves solving many puzzles; one of the hardest is how to successfully deal with patients who don’t pay their bills.   Many medical practices turn to collection agencies for help. Although, too many health care providers insist the percentage agencies don’t live up to their expectations: 

For many medical providers the age old question is, "should our practice be in or out of network?" The answer depends on your location and specialty. By this we find general primary care providers in large metro areas choose to be in network because limited payers, such as BCBS, Medicare and Medicaid and in competition for the same patients. Where patients are less restricted many medical practices find being out of network has advantages such as higher reimbursements for the same in network contracts. Probably the two highest drawbacks are the following:

If your practice accepts Medicare every provider must report at least one quality measure on one Medicare Part B patient (Not Medicare Advantage) on a 2013 date of service to avoid the 1.5% pay cut in 2015. Please see list of measures:

For the most part, supplies and materials are typically bundled with the service/procedure and are not payable separately. According to the AMA CPT guidelines, there are specific codes used to bill for supplies and materials.

According to published statistics and my experience auditing medical records, physicians mainly use code 99213 for established office visits and rarely, if not at all, use code 99214. I have seen many cases where the medical record warrants the higher level, however physicians automatically or routinely select the lower level code without any consideration for the higher one. This practice of under coding possess a potential loss of revenue and physicians may be shortchanging themselves.