United Healthcare Group’s Service Operations Virtual Career Fair June 26th & 27th

What inspires your life can transform your career. Access Virtual Environment June 26 & 27 | Recruiter Chat: 8:00-4:00 CT | Environment Open 24 Hours Thank you for registering to join UnitedHealth Group’s Service Operations Virtual Career Fair. During the event, you’ll learn about our diverse workforce, company culture and the many career path options […]

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2018 Bipartisan Budget Act Revises Stark Law Regulations-Part II

The Bipartisan Budget Act of 2018 (the “Act”), signed into law on February 9, 2018, contains an amendment that should cause physicians and healthcare providers to take note. Section 50404 of the Act, titled “Modernizing the Application of the Stark Rule under Medicare,” codifies recent Centers for Medicare and Medicaid Services (“CMS”) regulations and corresponding […]

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2018 Bipartisan Budget Act: Greater Access, Innovation, and Technology in the Administration of Medicare Advantage Plans-Part I

  Prior to adjourning for spring recess, Congress passed and the President signed into law on March 23, 2018, omnibus appropriations legislation that funds the government for the remainder of the fiscal year – through September 30. As part of the earlier negotiations to reach the budget deal, Congress passed and the President signed into […]

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Isn’t it time you beat the denial game?

Our Orthopaedic Health Team will address the significant denials challenge with effective, evidence-based guidance and strategies that cover the range of reasons for denied claims: Medical Necessity Medically Unlikely Edit (MUE) No Authorization Partial Authorization Insufficient Documentation Different Procedure Billed Than the Pre-authorized Procedure Outdated CPT® code Obsolete/Deleted Diagnosis Codes Modifier Error RAC (Recovery Act […]

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How Email And Texting Should be handled, And The Price of Getting It Wrong

Are you clear on how e-mail and texting patients should be handled? Do you know how the HIPAA enforcement process could impact your practice and business associates (BAs)? Do you have an exit strategy for BA breaches? Are you aware of what activities invite an audit and how to eliminate your risk? With ramped up scrutiny and greater risk exposure, complying with HIPAA regulations has […]

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New Medicare Card Project-Card Mailing Update

CMS has started mailing new Medicare cards to people with Medicare who live in Wave 2 states and territories: Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, and Oregon. We continue to mail new cards to people who live in Wave 1 states, as well as nationwide to people who are new to Medicare. […]

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Why is proper documentation important to you and your patients?

Importance Of Proper Documentation *Proper documentation ensures patients get items/services that are reasonable and necessary *Proper documentation supports proper claim payment *Proper documentation supports favorable medical review decisions Top 5 Errors #1 Insufficient Documentations (Does NOT mean documentation doesn’t exist) #2 Medical Necessity #3 Incorrect Coding #4 Other #5 No documentation Consequences Of Improper Documentation […]

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90 Days (+2) Major Surgery Global

Per national Correct Coding Initiative (CCI) Chapter 3 guidelines, a procedure with a 90 day global period “is defined as a major surgical procedure.” The 90 day global period actually extends to 92 days, to include one day before the day of the surgery, the day of surgery, and the 90 days immediately following the day of […]

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Medicare to Crack Down on Medical Necessity Errors with Heightened Claims Scrutiny in 2018

OIG believes that CMS didn’t have the tools to identify medical necessity, several coding errors, and documentation deficiencies-and could have saved nearly 36.7 billion in 2017 by auditing improper payments. As a result, the OIG is directing CMS to: 1. Establish new systems and monitoring to evaluate the appropriateness of claims. 2. Instruct Medicare Administrative […]

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How to have a seamless billing process

When most people hear the phrase, “seamless billing,” they often think of the operations on the back-end of the revenue cycle, after a claim has been submitted.   But seamless billing can only be achieved by best practices that happen before the claim is even generated. The revenue cycle starts with the first phone call […]

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Medicare: Reminder`Don’t balance bill Medicare Beneficiaries (QMB) eligible

Reminder: Don’t balance bill Medicare beneficiaries Under the Qualified Medicare Beneficiary (QMB) program for Medicare beneficiaries, providers can’t charge for cost sharing. State Medicaid programs may pay providers for Medicare deductibles, coinsurance and copayments. But federal law allows states to limit provider reimbursement for Medicare cost sharing under certain conditions. Dually eligible individuals may qualify […]

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OIG report Healthcare Fraud on Home Health Agency

Michigan Home Health Agency Owner Pleads Guilty to Health Care Fraud Charges for Role in $8 Million Medicare Fraud Scheme The owner of a Michigan home health agency pleaded guilty today to fraud charges for his role in a scheme involving approximately $8 million in fraudulent Medicare claims for home health services that were procured […]

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Make sure your Billing Staff are aware of these updates

Effective 8/13/2018` Change Request (CR) 10619 initiates both Medicare manual changes and operational changes related to the New Medicare Card. Medicare will replace the use of Remittance Advice Remark Code (RARC) MA61, referenced in the Medicare Claims Processing Manual, Chapters 1 and 27, with RARC N382 – missing/incomplete/invalid patient identifier (HICN or MBI). Effective for […]

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Passionate to get Life Moving Again

The rise of Musculoskeletal Disorders (MSDs) is proving to be a dire problem. From older generations to newer ones, MSDs are no longer just threating to the health of our bodies; these common disorders are a threatening our economy—our society—our way of life.  Spanning from minor fractures to the more serious cases such as osteoporosis, […]

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