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We are in an era of complex healthcare billing that can cost providers lost revenue due to lack of knowledge and proper training. Without these much needed tools, providers are faced with significant loss of revenue for their company. The good news is many of these mistakes are avoidable with proper checks and balances in place. Noted below are a few fundamental areas to pay special attention…   VERIFICATION OF BENEFITS    Accurate, upfront verification validation is a crucial step to avoid any future denials and loss of revenue before services have been rendered. Proper training and knowledge of the most vital questions to

What is a COBRA plan?   A COBRA plan is a private insurance option that gives people who may have just lost their job, time to find a new job, new insurance, and remain covered. COBRA is typically for when a patient is terminated from their job or they have to leave their job, and it is insurance that will cover in their grace period.    Several events that can cause workers and their family members to lose group health coverage may result in the right to COBRA coverage. These include: Voluntary or involuntary termination of the covered employee’s employment for reasons other than

Single case agreements are contracts between an insurance company and an out-of-network health care provider for specific patients for billing in particular cases. They allow out-network patients to benefits. from in-network billing benefits. There are two ways for billing after the approval of SCA. First, the insurance company provides the allowed amount, finalized as per the agreement. Second, the patient directly pays the total bill to their provider, which the insurance company reimburses according to the discounts as per the agreement. What Conditions Do Patients Have to Meet for a Single Case Agreement? For a single case agreement, you as a health care provider have to advocate

There are all sorts of therapies and rehab programs to treat substance abuse these days. However, recent studies and observations indicate substance abuse not always being a standalone problem. This information also implies that, for decades, it’s not just substance abuse that has been a problem, but also the way patients undergo treatment.  Providing proper care, diagnosis, and treatment programs for simultaneously occurring mental health and substance abuse issues are now the new challenge for the healthcare industry.  Health care industries face problems regarding the billing of treatment of co-occurrence of substance abuse and mental health. Billing Options of Mental Health and

Ancillary services are additional services, which are important to run an organization (not to be confused with ancillary services - electrical). They are set up to provide full service to the customers and also help increase revenues an organization’s revenue. In hospitals, ancillary services are the ones other than room, nursing, medical, and board services. Ancillary services in hospitals include radiology, laboratory, pharmacy, and physiotherapy services. Ancillary care and services are not only for the patients but for physicians, doctors, and nurses as well. Physicians and doctors can request ancillary care for the diagnosis and treatment, whenever required. Ancillary services are

Protecting Access to Medicare Act (PAMA) became a part of law on 1 st April 2014. The purpose of the act includes extending payments of Medicare physicians and other provisions. Instead of solving problems for healthcare facilities and clinical labs, these changes only complicated matters. PAMA introduced some vivid changes in the Medicare Clinical Laboratory Fee Schedule (CLFS). This resulted in some serious regulatory and reimbursement burdens on the laboratories. Under the act, the cost of most lab tests remained the same for Medicare Part B. But the prices of some common and important lab tests decreased. Changes in CLFS mean a 75% reduction in reimbursement. The reduction

Currently, many behavioral healthcare providers are turning toward the option of going in-network rather than away from it. For those who don’t know, the term in- network refers to the option of connecting with certain health programs and/or insurance companies at a negotiated rate in order to provide care to individuals who are covered by these programs. Behavioral healthcare providers, such as mental health and addiction treatment facilities, have sometimes shied away from this option in the past, but now, it’s becoming more and more popular in this field. Why is this happening, though, and is it a good idea for your facility? What Are the Benefits of Being an

If you’ve worked in the behavioral healthcare realm for more than a few months, you already know treatment services aren’t always utilized the way they should be. This is more often due to billing problems than treatment issues. Because of this, the utilization review process has disintegrated over time, and now providers need multiple full-time employees to deal with insurance companies, handle medical billing, process insurance claims, and pursue medical collections.

Value-Based Reimbursements change the game by offering outcome-based incentives to In-Network providers. Learn more about this important trend.Value-Based Reimbursements give In-Network providers an incentive to remain in a payer’s network, while tying a portion of their payments to patient outcomes. In doing so, the Value-Based system could help bring the cost of healthcare under control.And that’s not the only reason providers should embrace outcomes-based reimbursements. As of 2018 The Joint Commission will require outcomes-based data as a conditioned for accreditation. Other accreditation bodies are sure to follow suit.In this report, we look at how Value-Based Reimbursements, AKA “outcome-based reimbursements,” work

To run a successful healthcare practice, it’s important to diversity your payer mix. Here are 5 reasons why payer mix is more important than you thought. In Healthcare, having a solid and diverse payer mix can be the difference between running a thriving business and closing your doors. Having a diverse payer mix takes the power away from any one insurer. This gives you more control of your cash flow, and enables you to better predict how much money you’ll have at any given time.While this is a simple concept, it’s important to understand precisely how the differences in payer operations