First Line Defense: Preventing Denials Through Patient Eligibility Verification

March 22, 2024 | By Carol Ittig, MBA, CMPE Introduction: In the fast-paced world of healthcare billing, clean claims are the key to maximizing revenue and minimizing headaches. A significant contributor to claim denials is inaccurate patient eligibility information. This article explores a multi-step approach to patient eligibility verification, empowering your team to submit clean…

Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing

  February 2, 2024 | By Christine Hall, Senior Consultant, CHC, CPC, CPB, CPMA, CRC, CEMC, CPC-I Certified Instructor Navigating Healthcare Claims and Audits for Purchased Diagnostic Testing: In the complex world of healthcare, accurate reporting of services is crucial for ensuring quality patient care and fair compensation for medical providers. One significant aspect of this…

Recreating the Structure

  September 22, 2023 | By Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT Let’s get uncomfortably honest. With continued reimbursement cuts, like this year’s $9-12k per provider E/M cut, organizations cannot sustain 100% coding validation. Now, let’s get brutally honest. This is compounded by a lack of truly skilled and knowledgeable coders looking to fill the…

Determining Risk for Compliance Program

  November 18, 2022 | By Rhonda Buckholtz, Owner, Coding and Reimbursement Experts Determining risk is important for having an effective compliance program. Policies need to be developed to your specific needs. Depending on your specialty, your geographic area, your risk areas, etc. For example, yours might be diagnostic testing, modifiers, emergency evacuations, ASC rules,…

Culture in Compliance

  May 13, 2021 | By Rhonda Buckholtz, Owner, Coding and Reimbursement Experts For years we have talked about the culture in healthcare, especially for compliance purposes but for many practices that culture takes a back seat despite continued guidance. Culture is one of the most important features of a medical practice and for compliance…