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When it comes to medical billing and coding for small health care practice, like a family doctor’s office or a small specialty clinic, you would think that it would not be too hard to keep your medical coding and billing in-house. After all, if you don’t have an overwhelmingly large patient population, it seems like an office staff member or two could get the job done. However, you might be failing to account for the unexpected problems that you can’t predict — but that will inevitably slow down your revenue cycle. These kinds of problems easily fall into the category of “nobody’s fault,” but
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your practice still has to deal with them. One problem that is becoming increasingly common is name misspellings on insurance cards.
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Medicare provides health insurance coverage for more than 55 million Americans — over 15 percent of the population — and that number is expected to rise to about 79 million by 2030. Individuals who are 65 years or older, disabled, or have end-stage renal disease are eligible for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). However, many patients also have another form of insurance as well. That can make it difficult for medical billers to determine which payer is the primary insurance provider and which is the secondary (or tertiary) insurance provider.
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If you are a health care provider at a small practice, you might be surprised to find out that the auto insurance laws in your state have the potential to significantly impact your revenue cycle. This is particularly true in states that have “no fault” auto insurance laws. Under this type of system, the auto insurance company pays for damages from motor vehicle accidents — including medical bills — up to a certain limit, regardless of whether or not the driver was at fault. This means that the health care provider who treats the driver must contend with the complexities of personal insurance p
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rotection (PIP) billing.
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Last week, we looked at the ICD-10 and CPT coding systems, which are the two dominant code sets used for medical coding and billing in the United States today. However, if you’re billing Medicare, Medicaid, or one of a few other third-party insurance payers, you also need to be familiar with the Healthcare Common Procedure Coding System (HCPCS).
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In light of the growing epidemic of opioid addiction and overdose in the United States, the Division of Federal Employees’ Compensation (DFEC) within the Office of Workers’ Compensation Programs (OWCP) has issued new guidelines for workers’ compensation claims for opioid medications for federal employees. While the OWCP DFEC acknowledges that opioid medications are valuable for some injured workers, the Federal Employees Compensation Act (FECA) program believes that safety concerns justify more stringent standards.
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