Practice Management Alert
Revenue:
Improve Provider, Coder, Biller Relations, Improve Outcomes and Revenue
Three different roles, the same shared goals. In her HEALTHCON Regional presentation “D... Read more
Improve Provider, Coder, Biller Relations, Improve Outcomes and Revenue
Three different roles, the same shared goals. In her HEALTHCON Regional presentation “D... Read more
Coding:
Let These 3 Tips Lead You to New vs. Established Patient Clarity
You can collect more for new patients — but check these guidelines first. What's the di... Read more
Let These 3 Tips Lead You to New vs. Established Patient Clarity
You can collect more for new patients — but check these guidelines first. What's the di... Read more
Staffing:
Understand the 5 Challenges Remote Workers Face
Craft effective policies to maintain compliance. Remote workers face several challenges ... Read more
Understand the 5 Challenges Remote Workers Face
Craft effective policies to maintain compliance. Remote workers face several challenges ... Read more
Reader Questions:
Try ‘Office Hours’ to Boost Employee Focus
Question: One of our practice's expert coders is very generous with her knowledge and... Read more
Try ‘Office Hours’ to Boost Employee Focus
Question: One of our practice's expert coders is very generous with her knowledge and... Read more
Reader Questions:
Understand NPI Types
Question: Are there different kinds of national provider identifiers (NPIs) for indiv... Read more
Understand NPI Types
Question: Are there different kinds of national provider identifiers (NPIs) for indiv... Read more
Reader Questions:
Heed This Insight on Documentation Requests for CERT Reviews
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi... Read more
Heed This Insight on Documentation Requests for CERT Reviews
Question: Our practice is currently in the middle of a Comprehensive Error Rate Testi... Read more
MPFS:
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Service... Read more
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Service... Read more
Reimbursement:
Avoid These 8 Common Medicare Billing Errors to Keep Pay Flowing
Watch those dates of service, MAC addresses, and more. Your provider documented a claim ... Read more
Avoid These 8 Common Medicare Billing Errors to Keep Pay Flowing
Watch those dates of service, MAC addresses, and more. Your provider documented a claim ... Read more
E/M Coding:
Bolster Your Distinct Time Billing Knowledge
Remember to bill with only one provider's number. Both the Centers for Medicare & Me... Read more
Bolster Your Distinct Time Billing Knowledge
Remember to bill with only one provider's number. Both the Centers for Medicare & Me... Read more
Reader Questions:
Include These Elements on Orientation and CE Lists
Question: How can I make sure my nonclinical staff are trained, especially on crucia... Read more
Include These Elements on Orientation and CE Lists
Question: How can I make sure my nonclinical staff are trained, especially on crucia... Read more
Reader Questions:
Use This Checklist for Medical Necessity
Question: What are the core tenets of documenting and illustrating medical necessity?... Read more
Use This Checklist for Medical Necessity
Question: What are the core tenets of documenting and illustrating medical necessity?... Read more
Reader Questions:
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and... Read more
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and... Read more
Best Practices:
Dissect Your Workflow to Streamline Operations
Hint: Patient satisfaction is all about setting expectations. In a medical practice, orde... Read more
Dissect Your Workflow to Streamline Operations
Hint: Patient satisfaction is all about setting expectations. In a medical practice, orde... Read more
News You Can Use:
Hear From Those Affected by the Change Healthcare Outage
Reinforce your skills with paper-based claims. More than four months have passed since ... Read more
Hear From Those Affected by the Change Healthcare Outage
Reinforce your skills with paper-based claims. More than four months have passed since ... Read more
More News:
Feds Focus On Physicians In June Enforcement
Prescription fraud, E/M upcoding, and more factor in latest settlements. You might have n... Read more
Feds Focus On Physicians In June Enforcement
Prescription fraud, E/M upcoding, and more factor in latest settlements. You might have n... Read more
Modifiers:
Know These Modifier QW Dos and Don’ts
Hint: Check the CLIA list every time you're submitting a new lab test. Some coding modi... Read more
Know These Modifier QW Dos and Don’ts
Hint: Check the CLIA list every time you're submitting a new lab test. Some coding modi... Read more
Reader Questions:
Beware of Licensing Obligations
Question: My practice has received communications from the American Medical Associati... Read more
Beware of Licensing Obligations
Question: My practice has received communications from the American Medical Associati... Read more
Reader Questions:
Patients May Need to Choose Between Benefit Programs
Question: One of our patients mentioned to a nurse that he was receiving continuing g... Read more
Patients May Need to Choose Between Benefit Programs
Question: One of our patients mentioned to a nurse that he was receiving continuing g... Read more
Reader Questions:
Lean on Documentation for E/M of Services Not Actually Performed
Question: Can we count a provider's efforts to counsel a patient against a test as ev... Read more
Lean on Documentation for E/M of Services Not Actually Performed
Question: Can we count a provider's efforts to counsel a patient against a test as ev... Read more
Best Practices:
Try These Tips for Boosting Financial Literacy
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ma... Read more
Try These Tips for Boosting Financial Literacy
Hint: Make sure you involve physicians, so they understand the ripples of their work. Ma... Read more
Continuing Education:
Use This Guidance to Improve Your Coding Education Process
Check out these tips for more effective onboarding. Coding education is an ongoing effor... Read more
Use This Guidance to Improve Your Coding Education Process
Check out these tips for more effective onboarding. Coding education is an ongoing effor... Read more
Audits:
Establish Practice Protocols for Addressing A TPE Audit
Hint: Look at your MAC's focus to troubleshoot internal issues. Whether you've already s... Read more
Establish Practice Protocols for Addressing A TPE Audit
Hint: Look at your MAC's focus to troubleshoot internal issues. Whether you've already s... Read more
Reader Questions:
Find Flexibility in Delegating Prior Authorizations
Question: If a patient's prescribed medication needs a prior authorization from their... Read more
Find Flexibility in Delegating Prior Authorizations
Question: If a patient's prescribed medication needs a prior authorization from their... Read more
Reader Questions:
Be Careful About Disclaimers on Records
Question: One of the physicians at our practice uses dictation software, and the vend... Read more
Be Careful About Disclaimers on Records
Question: One of the physicians at our practice uses dictation software, and the vend... Read more
Reader Questions:
Get Clarity on Separate Procedures
Question: I've read that CPT® guidelines preclude coding some procedures together b... Read more
Get Clarity on Separate Procedures
Question: I've read that CPT® guidelines preclude coding some procedures together b... Read more
Best Practices:
Find Some Light in the Prior Authorization Maze
Hint: Don't forget to keep track of denials so you can troubleshoot your processes. Healt... Read more
Find Some Light in the Prior Authorization Maze
Hint: Don't forget to keep track of denials so you can troubleshoot your processes. Healt... Read more
Cybersecurity:
Take These 3 Tips, Use AI to Speed Through Unprocessed Claims
Here's how to streamline your workflow intelligently. Revenue cycle teams handle thousand... Read more
Take These 3 Tips, Use AI to Speed Through Unprocessed Claims
Here's how to streamline your workflow intelligently. Revenue cycle teams handle thousand... Read more
Reimbursement:
Avoid These 8 Common Medicare Billing Errors to Keep Pay Flowing
Watch those dates of service, MAC addresses, and more. Your provider documented a claim... Read more
Avoid These 8 Common Medicare Billing Errors to Keep Pay Flowing
Watch those dates of service, MAC addresses, and more. Your provider documented a claim... Read more
Reader Questions:
Focus on These Aspects of an Appeal Letter
Question: What information is crucial to include when I'm appealing a denied claim? ... Read more
Focus on These Aspects of an Appeal Letter
Question: What information is crucial to include when I'm appealing a denied claim? ... Read more
Reader Questions:
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber... Read more
Distinguish Medical Identity Theft From Other Types of Fraud
Question: Is medical identity theft a type of fraudulent claim? Minnesota Subscriber... Read more
Reader Questions:
Give Patients Tools to Boost Staff Morale
Question: How can I boost employee morale and keep track of all the great things my t... Read more
Give Patients Tools to Boost Staff Morale
Question: How can I boost employee morale and keep track of all the great things my t... Read more
Reader Questions:
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says w... Read more
Get the Skinny on Medicare Overpayment Timeline
Question: We've heard that Centers for Medicare & Medicaid Services (CMS) says w... Read more
Best Practices:
Consider These Tips to Monitor Employee Productivity
Hint: Look at workers' records over a defined period of time. Practice managers know that... Read more
Consider These Tips to Monitor Employee Productivity
Hint: Look at workers' records over a defined period of time. Practice managers know that... Read more
Documentation:
Study These Strategies for Setting Up a Solid CDI Process
Realize the benefits of regular self-audits. Comprehensive clinical documentation is the ... Read more
Study These Strategies for Setting Up a Solid CDI Process
Realize the benefits of regular self-audits. Comprehensive clinical documentation is the ... Read more
Training and Education:
Don’t Skimp On Sanction Policymaking, Feds Warn
Tip: Make employee training match duties. Stopping a data breach incident and retrievin... Read more
Don’t Skimp On Sanction Policymaking, Feds Warn
Tip: Make employee training match duties. Stopping a data breach incident and retrievin... Read more
Reader Questions:
Sign-In Sheets Still OK
Question: One of the physicians in my practice demands we use a sign-in sheet—he says th... Read more
Sign-In Sheets Still OK
Question: One of the physicians in my practice demands we use a sign-in sheet—he says th... Read more
Reader Questions:
Rely on Addendums for EHR Mistake Corrections
Question: How should we correct a mistake in an electronic health record (EHR)? Montana S... Read more
Rely on Addendums for EHR Mistake Corrections
Question: How should we correct a mistake in an electronic health record (EHR)? Montana S... Read more
Reader Questions:
Wearable Technology May Bring Peace of Mind
Question: I have several patients who suffer from epilepsy that is well controlled with me... Read more
Wearable Technology May Bring Peace of Mind
Question: I have several patients who suffer from epilepsy that is well controlled with me... Read more
Reader Questions:
Define Stable Condition
Question: Is there any difference between a chronic condition and a stable condition, espe... Read more
Define Stable Condition
Question: Is there any difference between a chronic condition and a stable condition, espe... Read more
Industry News:
Did You Feel Shockwaves From the Blackcat Attack?
The cyberattack underscores the interconnectedness of U.S. healthcare. The Blackcat cybe... Read more
Did You Feel Shockwaves From the Blackcat Attack?
The cyberattack underscores the interconnectedness of U.S. healthcare. The Blackcat cybe... Read more
Revenue:
Capture These Tips to Stall Denials
Make sure your billing team feels empowered to communicate well. Denials easily cross th... Read more
Capture These Tips to Stall Denials
Make sure your billing team feels empowered to communicate well. Denials easily cross th... Read more
Payers:
Acknowledge the Need for Strong Relationships with Payers
Getting glimpses of the payer experience is a good first step. While providers may not be... Read more
Acknowledge the Need for Strong Relationships with Payers
Getting glimpses of the payer experience is a good first step. While providers may not be... Read more
Reader Questions:
Bulk Up Your Documentation With M.E.A.T.
Question: What, exactly, does M.E.A.T. stand for in the medical context? Oregon Subs... Read more
Bulk Up Your Documentation With M.E.A.T.
Question: What, exactly, does M.E.A.T. stand for in the medical context? Oregon Subs... Read more
Reader Questions:
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures... Read more
Employ Protections for Patient Signatures
Question: In our recent risk evaluation, we discovered that the electronic signatures... Read more
Reader Questions:
Be Careful With Complexity for Undiagnosed Condition
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
Be Careful With Complexity for Undiagnosed Condition
Question: Does an undiagnosed new problem with uncertain diagnosis automatically mean... Read more
Back to Basics:
Delve Into ‘Medical Necessity’
Hint: You may not need to conflate medical necessity with clinical care. The phrase “me... Read more
Delve Into ‘Medical Necessity’
Hint: You may not need to conflate medical necessity with clinical care. The phrase “me... Read more
E/M Services:
Find Clarity on Providing E/M Services for Medicare Beneficiaries
And remember: Other payers may adopt these guidelines, too. In many coding roles, knowing... Read more
Find Clarity on Providing E/M Services for Medicare Beneficiaries
And remember: Other payers may adopt these guidelines, too. In many coding roles, knowing... Read more
Mythbusters:
Don’t Let the Internet Be the Wild West for Your Provider
Discover your responsibilities in protecting patient internet use data. Most websites co... Read more
Don’t Let the Internet Be the Wild West for Your Provider
Discover your responsibilities in protecting patient internet use data. Most websites co... Read more
Reader Questions:
Respond to Record Requests With These Tips
Question: What's the best way to respond to a documentation request from another physician... Read more
Respond to Record Requests With These Tips
Question: What's the best way to respond to a documentation request from another physician... Read more
Reader Questions:
Explore Potential Outcomes of SDOH
Question: I know there's a huge push to document social determinants of health (SDOH) for ... Read more
Explore Potential Outcomes of SDOH
Question: I know there's a huge push to document social determinants of health (SDOH) for ... Read more
Reader Questions:
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and a lo... Read more
Distinguish NCD From LCD
Question: What's the difference between a national coverage determination (NCD) and a lo... Read more
Audits:
Take Preparations Now for TPE Resurgence
Don't risk making these common errors. The Centers for Medicare & Medicaid Services (... Read more
Take Preparations Now for TPE Resurgence
Don't risk making these common errors. The Centers for Medicare & Medicaid Services (... Read more
Best Practices:
Beware of Healthcare Workplace Violence
Look out for legislation and regulations that acknowledge dangers for healthcare personnel... Read more
Beware of Healthcare Workplace Violence
Look out for legislation and regulations that acknowledge dangers for healthcare personnel... Read more
Modifiers:
Find Clarity With These Modifier FAQs
Boost your modifier usage knowledge to avoid reimbursement woes or headaches from audits. ... Read more
Find Clarity With These Modifier FAQs
Boost your modifier usage knowledge to avoid reimbursement woes or headaches from audits. ... Read more
Reader Questions:
Find CERT Info via Hub
Question: Are there any resources available to help folks navigate the Center for Me... Read more
Find CERT Info via Hub
Question: Are there any resources available to help folks navigate the Center for Me... Read more
Reader Questions:
Acknowledge HC3 Advice
Question: We've been shopping for new software for our healthcare practice and haven'... Read more
Acknowledge HC3 Advice
Question: We've been shopping for new software for our healthcare practice and haven'... Read more
Reader Questions:
Don’t Discount Smartwatch Data
Question: I am training as a scheduler, and a patient called in saying that their sma... Read more
Don’t Discount Smartwatch Data
Question: I am training as a scheduler, and a patient called in saying that their sma... Read more
Managed Care:
Pocket This Managed Care Primer
Shore up your managed care know-how before the OIG comes knocking. The Office of Inspecto... Read more
Pocket This Managed Care Primer
Shore up your managed care know-how before the OIG comes knocking. The Office of Inspecto... Read more
HR Corner:
Don’t Let a Stark Violation Masquerade as a Gift
Establish and review policies, and make sure staff understand their responsibilities. Th... Read more
Don’t Let a Stark Violation Masquerade as a Gift
Establish and review policies, and make sure staff understand their responsibilities. Th... Read more
Modifiers:
Expand Your Knowledge of NCCI Edits
Hint: Understanding context is crucial information for accurate coding. Most coding sof... Read more
Expand Your Knowledge of NCCI Edits
Hint: Understanding context is crucial information for accurate coding. Most coding sof... Read more
Reader Question:
Be Honest About Qualifying for Home Visit
Question: My provider wants to bill 99350 when performing a home visit via telehealth... Read more
Be Honest About Qualifying for Home Visit
Question: My provider wants to bill 99350 when performing a home visit via telehealth... Read more
Reader Question:
Think Beyond Reimbursement for Z Codes and Medical Necessity
Question: Do Z codes really affect reimbursement, or are they mostly designed to pad ... Read more
Think Beyond Reimbursement for Z Codes and Medical Necessity
Question: Do Z codes really affect reimbursement, or are they mostly designed to pad ... Read more
Reader Question:
Be Sensitive When Gathering Demographic Information
Question: I work as a scheduler and recently heard a colleague on the phone with a pa... Read more
Be Sensitive When Gathering Demographic Information
Question: I work as a scheduler and recently heard a colleague on the phone with a pa... Read more
Practice Management:
Maintain or Even Boost Practice Margins With These Tips
Rely on evaluations and engagement to bolster your healthcare business. “One of the thi... Read more
Maintain or Even Boost Practice Margins With These Tips
Rely on evaluations and engagement to bolster your healthcare business. “One of the thi... Read more
Practice Management:
Remember Copays are Contractual
Question: Can front desk staff waive copays at their discretion? For example, if a patient... Read more
Remember Copays are Contractual
Question: Can front desk staff waive copays at their discretion? For example, if a patient... Read more
Practice Management:
Read the Fine Print on Payer Policies for Medical Necessity
Question: Isn't preventive care implicitly medically necessary? Massachusetts Subscriber ... Read more
Read the Fine Print on Payer Policies for Medical Necessity
Question: Isn't preventive care implicitly medically necessary? Massachusetts Subscriber ... Read more
Practice Management:
Avoid These Common Documentation Shortcuts
Question: I know illegibility has historically been an obstacle to good documentation. My ... Read more
Avoid These Common Documentation Shortcuts
Question: I know illegibility has historically been an obstacle to good documentation. My ... Read more
Practice Management:
Protect Your Practice From Potential Fraud
Training your office staff and correctly billing patients is key to avoiding fraudulent cl... Read more
Protect Your Practice From Potential Fraud
Training your office staff and correctly billing patients is key to avoiding fraudulent cl... Read more