Insights
Notes on reimbursement, audits, coding, and the rules that move a healthcare revenue cycle.
February 19, 2025
Check out the latest project from Joe Rivet! Both e-books and physical copies are available. This is a single resource that has distilled the No Surprises Act and the states balance billing laws…
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February 18, 2025
Effective March 1, 2025, BCBSM will begin enforcing a long-standing policy against hospitals that repeatedly appeal claims. This policy applies to external review appeals. Hospitals will have to…
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February 17, 2025
States are closely scrutinizing payers who are frequently denying treatments. The California senate has recently put forward SB 363, a bill that could bring about significant changes in the…
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January 15, 2025
The Office of Civil Rights (OCR) imposed a $100,000 penalty against a California mental health facility, Rio Hondo Community Mental Health Center. The violation was levied against the practice for…
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January 15, 2025
A hospital in Virginia agreed to pay $2,378,731.06 for submitting claims to Medicaid that were improperly modified by the request of the practice’s employee. Here is the press release. This is a…
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January 15, 2025
Verification of Benefits (“VOB”) occurs nearly daily, and the practice relies on the information provided by the payer. Yet, if the payer gets it wrong, can the practice still force reliance on…
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January 15, 2025
CMS Issued Transmittal 13015 on December 23, 2024, covering expanded reporting of G2211. CMS allows payment for G2211 when certain Part B Preventive Services are provided on the same day,…
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September 12, 2024
The average denial rate is 18.12% for in-network claims based on data reported from the Health Insurance Exchanges. Much of that is low-hanging fruit. During this intensive training, presenter Joe…
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Events
September 12, 2024
Third Party Payer Day is a premier event for medical billers, coders, reimbursement managers, practice administrators, and other professionals involved in the revenue cycle or billing process.…
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