Joseph Gestetner的动态

It's been a great day of reviewing the Centers for Medicare & Medicaid Services' updates, collaborating on new provider playbooks, and revising compliance and regulatory programs with North Carolina HFMA (NCHFMA) and Palmetto GBA at Novant Health. This is a good time in the year to refresh your content and educate teams on Provider Audit and Reimbursement (PARD) responsibilities (ensuring appropriate payments to #Medicare providers according to the Medicare law, regulations, and interpretative guidelines published by #CMS). ?? Cost Report Receipt and Acceptance/Rejection ?? Issuance of Tentative Settlements ?? Cost Report Reviews (Desk Reviews/Audits/Wage Index/S-10 Audit) ?? Cost Report Reopenings ?? Cost Report Appeals ?? Interim Rate Reviews ?? Accuracy of Provider-Specific File ?? Computation of Hospice Payment Cap ?? Provider-Based Determinations ?? Review Request for Special Payment Status?? Background: Under 42 CFR 413.20 (a), all providers participating in the Medicare program, whether paid on a reasonable cost basis or through a prospective payment system, must maintain sufficient financial records and statistical data to determine costs properly. MACs review the records and data because the data from the cost report is used for payment reimbursement and various rate-setting and payment refinement activities. CTA: Equip your providers and teams with resources to understand Medicare cost reporting to their designated MAC. 1?? https://lnkd.in/eyGygFYg 2?? https://lnkd.in/esJ7NmXp

Understanding Relative Value Units (RVU) and Their Role in Medical Coding Relative Value Units (RVUs) are a fundamental part of the healthcare reimbursement system in the United States. They serve as a tool to quantify the value of medical services provided by healthcare professionals, helping to determine the payment rates for services under government programs such as Medicare, as well as private insurance providers. This article explains what RVUs are, how they are calculated, and their use in medical coding and billing.

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??The $48,000 Difference = Your Patient Advocate! Here's what your patient advocate can do for you: 1??? Negotiate Bills & Pre-Price Procedures: These medical billing experts can pre-price your doctor-ordered procedures, so that you don't overpay for services, as well as negotiate medical bills and even get erroneous charges erased. 2??? Explain Your Coverage: They can break down confusing insurance plans, helping you understand what’s covered - many people struggle through this alone, resulting in surprise bills and extra stress. 3??? Appeal Denied Claims: These experts can step in and appeal on your behalf. There are several ways patient advocates can be compensated for their services, some work on retainer, but many collect a percentage of the savings. So if you saved $48,000 on a surgery bill, you could expect to owe 20%-35% of those savings to your patient advocate (or about $9,600 - $16,800). If that sounds like too big a price tag - we agree! ?? That's why Revolt Healthcare Alliance, offers access to our team of medical billing experts to every policyholder! Our team has been able to get surprise bills erased completely, as well as help you find local, affordable procedures without the insane $50,000+ markups! ?? Find out how you can save thousands on healthcare—Link in bio #PatientAdvocate #SaveMoney #Healthcare #RevoltHealthNetwork #parallelhealthcareeconomy #MedicalBills #devolutionhealthcare

Receiving?denial?codes?from payers, even occasionally, can wreak havoc on a practice’s financials, leading to lost revenue and operational setbacks. In fact, nearly 15% of private payer claims and 15.7% of Medicare Advantage claims are initially denied, with an average?denial?costing providers around $14,000. Understanding the in’s and out’s of the top medical billing?denial?codes?is imperative for those looking to protect their revenue stream. Read our latest blog to learn about the most common?denial?codes, how to prevent them, and what steps to take to maintain your bottom line. #DenialManagement #MedicalBilling #RCM #RevenueCycle #RevenueCycleManagement

Current Procedural Terminology (CPT) codes are a standardized system of alphanumeric codes used to describe medical, surgical, and diagnostic procedures and services. Universal language for healthcare providers to communicate with insurance payers. By assigning the correct CPT codes to procedures and services, healthcare providers can ensure accurate and timely reimbursement and reduced Claim Denials

Kick the month off right by downloading these insightful thoughts on how to start your journey into navigating the world of wound care reimbursement. https://okt.to/NfXeZ1

When it comes to healthcare, understanding the difference in median insurance reimbursement rates across various payers is essential. Below is a snapshot of the median reimbursement rates for CPT 73721 (MRI of a hip, knee, or ankle) among four top payers. What can Providers do with this data? Leverage these insights to negotiate more favorable provider contracts at market average rates. Not sure where to begin? Get in touch, we will provide you with a complimentary reimbursement rate analysis.

Understanding the common causes of medical claims denials can help healthcare providers prevent costly delays and reduce frustration for patients. From incorrect patient information to missing pre-authorizations, learn how addressing these issues can streamline the billing process and improve revenue cycle efficiency. Explore four key reasons for claim denials and how to avoid them: https://buff.ly/4eQP9CL #MedicalClaims #ClaimsProcessing #Billing #RevenueCycle

Part of Revenulytics end-to-end revenue cycle management is Contracting and Credentialing with various healthcare payers. We at Revenulytics aim to help our providers to save time and achieve a smooth transaction with various insurances. Learn more about the difference between these two processes by visiting our website at?https://lnkd.in/g4bQn8XW #Revenulytics #RCM #Contracting #Credentialing