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Physician Stark Law Rules Revamped: New Rules Address Care Coordination

This is the first major update to rules for the Stark law since 1989, according to HHS. An HHS press statement explained that the new rules would give providers in value-based arrangements “greater certainty” and “ease the compliance burden for healthcare providers across the industry,” while maintaining protections against fraud and abuse. Clinicians and hospital

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3 Benefits of Value-Based Care

The U.S. healthcare industry is moving toward value-based care, encouraged by reimbursement initiatives from the Centers for Medicare and Medicaid Services (CMS). In a value-based model, providers are paid depending on patient outcome rather than on volume of procedures performed. Theoretically, this would promote a focus on patient wellness and preventative medicine, which would improve

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CMS Delays Collapsing of E/M Payment Rates Until 2021

Implementation of a single E/M payment rate for office visit Levels 2 through 4 won’t go into effect until 2021, CMS stated in the new Physician Fee Schedule rule. November 01, 2018 – CMS will collapse evaluation and management (E/M) payment rates, but not until the 2021 calendar year, according to the recently released final 2019

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American medical students less likely to choose to become primary care doctors

Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields. A record-high number of primary care positions was offered in the 2019 National Resident Matching Program—known to doctors as “the Match.” It

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CMS Is Putting Primary Care First

Beginning January 2020, primary care practitioners may qualify to participate in one of five new payment model options that focus on supporting care for patients who have chronic conditions and serious illnesses. The Centers for Medicare & Medicaid Services’ (CMS) Primary Care Initiative is a new set of payment models that will provide primary care

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When A Doctor’s Screen Time Detracts From Face Time With Patients

As Wei Wei Lee sat with her doctor to discuss starting a family, she felt a “distance” between them. The physician was busy on the computer and focused on the screen. Health care — and how much it costs — is scary. But you’re not alone with this stuff, and knowledge is power. “An Arm

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Can an ACO Benefit Independent Physicians?

An Accountable Care Organization (ACO) is a voluntary association of healthcare providers that bases physician reimbursement on performance quality and outcomes in order to lower overall costs. This method incentivizes physicians to deliver higher-quality care at an affordable cost, and is replacing the traditional fee-for-service model that has dominated healthcare in the past. The Medicare

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Medicare’s New 'Preclusion List'

By way of background, let’s start with a short Medicare primer. The federal Medicare program is a government health insurance program that pays for certain health care services for individuals who are 65 or over and have paid into Social Security and Medicare through payroll taxes for the required periods; certain younger people with disabilities;

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What Physicians should know about Value-Based Payment Models

Payment models have undergone numerous and frustrating changes over the past few years, and the implementation of the value-based reimbursement model is no exception. Physicians submitting claims to Medicare have likely experienced the changes relating to this payment model. Value-based reimbursements are/were intended to compensate providers based on performance and guidelines focused on improving patient

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Billing Process Tips that Increase Revenue

Treating patients is your job. So too is getting paid. Unless you belong to a large medical group, chances are that your staff is taking care of billing for you. Small practices are especially at risk of delayed payments for a variety of reasons. Approximately 83% of physician practices with fewer than five practitioner states

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Value of Outsourcing Your Billing Services

You have a busy medical practice with a steady flow of patients. You should be making a profit, but for some reason you’re not. Instead of waiting weeks for payments, you wait for months.  Why? In many physicians’ offices, billing tasks are relegated to a staff member not trained or certified to provide such services.

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Identify your Practice’s Billing Challenges to Reduce Delays and Increase Revenue

Physicians have enough on their plate without having to micromanage back-end office staff. That often happens when billing challenges start digging into your bottom line. If your office staff doesn’t keep up with coding changes, timely submission and requests for additional information with claims, or uses the wrong billing codes for reimbursement, your revenue cycle

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Manual Claim Checks - What’s at Stake for your Organization?

Does your practice manually contact payers to check your claim status? Are you aware that doing so costs roughly $7 per attempt? Your revenue cycle management processes are vital to the financial health and wellness of your practice. Poorly managed handling of claim status inquires costs you not only money, but precious time. A few

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Medical Billing Challenges for Private Physician Practices

A private medical practice’s success is reliant on revenue cycle management, accurate and timely claims submissions, and prompt reimbursement from insurance carriers. That said, it’s not unusual for a private practice physician to have to wait weeks or longer to receive payments. Even when reimbursement is received, it’s often much less than they charge for

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Study: Patients Prefer Electronic Billing for Healthcare Services

According to a recent survey by Waystar and HIMSS Analytics, the majority of hospitals, health systems, and outpatient facilities continue to bill patients with paper statements. Although paper billing is a standard practice, more than half of the 1,000 patients surveyed said that they prefer electronic billing and payment. Electronic billing aligns with how patients

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Study: 30% of Patients Leave Doctor's Office After Long Waits

A recent study by Vitals showed that up to 30% of people end up leaving without seeing their physician because the wait is too long. Each patient who leaves due to frustration could be a missed opportunity for revenue for the doctor’s office. In fact, 1 in 5 patients reported changing their doctor because of

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How to Prepare Your Practice for the New Medicare Card

As you have most likely heard, as of April of 2018, the Center for Medicare and Medicaid Services began mailing new Medicare cards to all active beneficiaries. These cards no longer have the Social Security number included on the cards in an attempt to minimize the threats of identity theft. Instead, the card will identify

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6 Ways to Optimize Your Practice's Revenue Cycle

For medical practices such as yours, revenue cycles have been majorly impacted by changes in the healthcare industry in the last 10 years. Not only have Medicare and Medicaid reduced physician’s reimbursement, but the submission requirements on claims have become a lot more strict. If you are not on top of your game, it is

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How to File a Medicare Claim That's Accepted the First Time

Even though 15% of the population in the U.S. are enrolled in Medicare, many medical billers are still having a hard time figuring out how to successfully file a Medicare claim. There are a lot of details to keep track of, and if you don’t, it is very easy for your claim to be rejected.

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No More Denials! The Secret to Successfully Processing Claims

There is no denying that you need to stay on top of processing claims to ensure that your business is being adequately reimbursed. Yet, claim management has the tendency to be tricky. In fact, one in every 10 medical claims is at risk of being denied! If you are finding yourself with a stack full