Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
The December Revenue Cycle Checklist: Timely Filing, Holidays and January Resets
December is when unworked claims expire and January problems are created. Here is the checklist we run with practices every year: timely filing sweeps, payer holiday cutoffs, the deductible reset conversation, re-verifying Medicaid patients after a year of unwinding, and the IDR portal reopening.
The HHS Cybersecurity Concept Paper: What a Small Practice Should Take From It
On December 6, 2023, HHS published a concept paper on cybersecurity for the health sector: voluntary performance goals, hospital incentives, a HIPAA Security Rule update and enforceable standards. Most of it targets hospitals. Here is what an independent practice should do anyway.
Hiring and Training Medical Billers When Experienced Staff Are Scarce
Every practice manager we talk to this fall has the same open position. Here is what we have learned about hiring billers in a tight market: what to test for instead of years of experience, a 90-day training plan that produces a working biller, and the retention mistakes that send them to the hospital across town.
Medicare Advantage Now Covers a Majority: Preparing Your Practice for January
Medicare open enrollment runs October 15 to December 7, 2023. KFF reports that 30.8 million people, 51% of eligible beneficiaries, are in Medicare Advantage this year. Here is what plan switching does to a practice in January, what the CMS-4201-F prior authorization rules change on January 1, and how to prepare now.
Writing Denial Appeal Letters That Actually Get Read and Overturned
Most appeal letters fail before a reviewer reaches the second paragraph. Here is the structure we use, the three denial types where a letter is worth writing, the documents to attach, the deadlines to log, and the mistakes that get an otherwise good appeal sent back unread.
Billing Staffing Shortages in 2023: Running the Revenue Cycle With Fewer People
MGMA polling this spring found coders and billers are the hardest revenue cycle roles to fill, and turnover in business operations staff topped 33% last year. Here is how the practices coping best are cutting rework, automating the repetitive checks, cross-training, and deciding what to send out.
ChatGPT in the Billing Office: What Generative AI Can and Cannot Do in 2023
Six months after ChatGPT launched, billers and practice managers are already pasting denial letters into it. Some of that is useful and some of it is a privacy incident. Here is what these tools do well today, where they fail at coding and payer rules, and the three-rule policy every practice should write this month.
Front-Desk Collections in 2023: Copays, Deductibles and Newly Uninsured Patients
Cost sharing is back on COVID-related visits, deductibles keep rising, and some of your patients are uninsured for the first time in three years. Here is how to estimate what is owed before the visit, the script that works at the desk, a card-on-file policy that holds up, and the statement cycle that follows.
Eligibility Checks After the PHE: Rechecking Medicaid Coverage at Every Visit
Six weeks into the Medicaid unwinding, the first states have posted termination numbers and most people losing coverage are losing it for paperwork reasons. Here is how the 271 response shows what changed, the pre-visit and day-of checks that catch it, and what to do with claims for patients who are later reinstated.
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The same people who write these articles run billing, coding, denial management and credentialing for practices nationwide.