MES Peer Review Services的动态

At PRS, our devotion to excellence is shown through our quality assurance program with clinical oversight on every case. Contact us today to learn more- https://lnkd.in/gKDA-tu #QA #IRO #peerreviewservices #peerreviewclaims #claimsservices #medicalclaimreview #clinicaloversight

Delve into the complex relationship between CMS and TCPA one-to-one consent requirements and learn how to effectively navigate them ?? https://ow.ly/MiaV50Th7l0 #activeprospect #consentbasedmarketing #tcpa #cms #consent #compliance #tcpacompliance #fcc

The best way to protect your healthcare license, your practice, and your freedom is by doing the following; 1. Hiring an expert healthcare compliance company like Chapman Consulting Group to conduct a full front to back door inspection of your practice to identify and mitigate risks and red flags. 2. Establishing and maintaining a robust compliance plan. 3. Improving documentation to best shield you from regulatory, insurance, and criminal scrutiny. Don’t wait until your license is in jeopardy to do what is right to protect yourself! #healthcarefraud #physician #compliance #compliancesolutions #controlledsubstanceprescribing #medical #documentation #healthcarecompliance #doctor #painmanagement #protectwhatmatters #redflags

Compliance is all about demonstrating a good-faith effort, and creating a culture within your organization to detect and prevent fraud, waste and abuse. While building an effective compliance program has costs associated with it, it doesn't have to be a budget buster. There are many very good compliance companies out there but there is only 1 #ComplianceGuy! Let my team and I help you build an effective compliance program that withstands the scrutiny of any insurance company or governmental agency. Relying on my 30 years of experience working for the nation's largest integrated delivery health systems in senior positions of significance, consulting with the DOJ, serving as an Independent Review Organization (IRO) for OIG, supporting Attorneys General across the country in qui tam cases, and my experience in more than 2-dozen federal civil/criminal cases over the past 10 years, and serving as a compliance officer for some of the nations most respected healthcare groups allows me to focus on the specific areas of risk by specialty and geographical location to ensure you are taking precise steps to mitigate your risk(s). What we Provide: 1. Comprehensive Gap Analysis to identify areas of risk/vulnerability. 2. Creation of a customize compliance plan and development of specific policies and procedures for YOUR organization. This is not a template or generic program... 3. Rolling out the compliance program to all employees to ensure understanding and then ongoing training for staff. 4. Monitoring and Auditing of the program to ensure ongoing compliance. 5. Coding and Medical Necessity Documentation Reviews of provider's services (E/M, Surgical Procedures, Modifiers, CCI Edits, Diagnostic Services, and other Ancillary Services. 6. Cost effective, third-party compliance officer services for those organization that do not have the internal resources. For more information or to discuss your needs please email me at [email protected] or visit my website www.thecomplianceguy.com DoctorsManagement, LLC

How CMS 1:1 Consent Differs from TCPA 1:1 Consent I've been receiving a lot of questions about the CMS final rule that went into effect on 10/1/2024, particularly regarding how it differs from the TCPA law on 1:1 consent. Disclaimer: I am?not?an attorney. This post is for educational purposes only—please consult your TCPA attorney for legal advice. I highly recommend watching this video, where I've highlighted some key timestamps. You can find the source link in the comments. To locate specific information, use CTRL + F and search for "Beneficiary Data" to find more information on data sharing. Just trying to help out my fellow Insurance Broker Friends. Here are the important timestamps: 14:05?- Manual dials included (Cell Phone) 17:23?- Must check the box (still clarifying this for brands) 21:57?- Section 6A: Data transferring 27:32?- Definition of sharing 29:42?- Affiliation to a company is "not good enough" (Example: FMO passing leads to independent agents) 33:07?- Carriers and downstream entities 35:48?- Stop calling old/aged leads effective 10/1 without 1:1 consent 38:37?- Pre-checked boxes for data sharing 40:39?- Where does responsibility lie? (All parties) 46:00?- Actionable advice If you are BUYING leads from Lead vendors. PLEASE, PLEASE, PLEASE make sure they are using proper opt ins. You must be able to produce that "written expressed consent"..... an excel spreadsheet or API into CRM does not count as proof if you follow. Make sure those live transfers meet the CMS Rule (TCPA goes into effect in Jan. 2025) Always consult your FMO Compliance department and make SURE they meet. There is a "HUGE' emphasis with CMS on data Sharing of TPMOs which is slightly more strict than the TCPA ruling. Another BIG different was the "MANUAL CALL" which includes Cell phone. This is not post is not for Bi@$&ing. Its to keep you informed. Let's not get negative in the comments lol I also questions Physicians and Medical Groups sharing Beneficiary Data to Brokers and FMO's?? Let's hear some thoughts from the Big Boys and Girls .....

The Hidden Impact of Claims Management on Patient Experience ?? As we dive deeper into the world of claims management, I want to highlight how crucial it is to the patient experience. In my journey through healthcare, I have seen how effective claims management can make a world of difference for both patients and providers. ?? Here are a few key takeaways: ?? Streamlined Processes: When claims are processed efficiently, patients can move through the healthcare system with less stress, leading to higher satisfaction. ?? ?? Clear Communication: Open conversations about what’s covered and what isn’t can prevent those last-minute surprises. When patients know what to expect, it builds trust between them and their healthcare providers. ?? ?? The Role of Healthcare Professionals: This is where healthcare professionals come into play. By accurately documenting patient information and understanding insurance requirements, we can reduce claims denials significantly. Engaging staff in the claims process not only boosts their confidence but also helps them support patients better. An informed team can tackle concerns and navigate the complexities of claims management, enhancing the overall patient experience. ???? I would love to hear your thoughts! How has claims management impacted your experience in healthcare? What strategies have you found effective in preventing claims denials?(I mean genuine cases here ??) I share a personal story for context in the comments section. Let’s keep this conversation going! Your experiences and insights could help us all improve claims management and patient experiences in our facilities. ???? #ClaimsManagement #PatientExperience #HealthcareLeadership #Collaboration #HealthcareInnovation #RevenueCycleManagement

We're not just here to protect claims. We're here to protect your PRACTICE! ?? Lovely Physicians Let’s see if have ever come across the following Messages ?? “You’ve been selected for a medical billing audit.” ?? “We help with audits. Our services include: ?? Documentation Review ?? Coding Compliance ?? Staff Training ?? Internal Audits ?? Audit Response Preparation Etc The same promises you’ve heard over and over, right? I’m sure a lot of companies offer decent audit support. ?? But, maybe there’s another level of commitment?? ?? Someone who actually prepares your practice to be audit-proof! Here’s some of what MD Revenue Group has done to keep our clients secure this year: - Conducted audits to catch issues early for clients. - Simplified documentation for clear, inspection-ready files. - Trained teams to avoid common high-risk patterns. - Achieved a 100% pass rate in CMS audit. - Helped new client cut denied claims by 40%. - Referred two practices to top compliance consultant. And yes, we do more than just review a few files and call it a day. It’s about making sure our clients can breathe easy knowing their practice is secure! But it’s not all about preventing audits: - Saved providers thousands by reducing risks. - Moved practices to electronic statements, fewer errors. - Cut client costs in billing and insurance. We’re here to PROTECT YOUR PEACE OF MIND! ????? Look, we know LinkedIn is filled with big wins and major industry numbers. But for the healthcare professionals who are in it day-to-day, these proactive steps can mean the world: - Reduce stress ?? - Free up time for patient care ?? - Avoid hefty audit fees ?? - Build a more resilient practice ?? Thanks for reading to the end. If you need any kind of help regarding that book a free consultation call - no string attached

?????? ???? ?????? ???????????? ?????????????? ???? ?????????????????? ?????????? ? Mastering insurance coding and documentation is essential for passing audits and reducing claim denials. ?? In this video, I share key strategies for aligning documentation with CPT and diagnosis codes, properly documenting E&M services, and the importance of regular audits to ensure compliance. #InsuranceClaims #medicalcoding #EMservices #CPTCodes #MedicalDocumentation #HealthcareCompliance #AuditSuccess

?????????? ?????????????????????????? ???????????????? ???????????????? ???? ?????????????? ?????????????? ?????????????? ?????????????????? Navigating insurance requirements can be challenging. At Express Medical Billing Solutions, we streamline the prior authorization process, ensuring timely approvals and reducing your administrative burden. ?????? ???????????? ????? ??????????????????: Experienced professionals familiar with various insurance guidelines. ?????????????????????????? ??????????????: From initial requests to follow-ups and appeals. ????????????????????: Advanced systems expedite authorizations, minimizing delays. ????????????????????: Up-to-date with the latest regulations and insurance policies. ??????????????-????????????????: Swift authorization processes improve patient experience. ?????? ?????????????? ?????????????????????? ??????????????????: Collect necessary patient information and documentation. ????????????????????: Submit accurate and complete authorization requests. ????????????-????: Track status and address additional requirements. ????????????????????: Inform providers and patients promptly upon approval. ??????????????: Handle appeals with additional documentation if necessary. ???????????????? ?????????????? ???????????????????????????? ????????????: More time for patient care. ?????????????????? ???????????????? ??????????: Higher likelihood of first-time approvals. ???????????????? ???????? ????????: Faster approvals and quicker reimbursements. ???????????????? ?????????????? ????????????????????????: Timely care improves outcomes. ?? ?????????????? ???????? ????: ?? Website: expressmbs.com ?? Email:[email protected] ?? Phone: (727) 353-2411 #ExpressMedicalBilling #RapidBillingSolutions #EfficientMedicalBilling #QuickClaimsProcessing #SwiftBillingServices #SpeedyRevenueCycle #ExpressClaimSubmission #EffortlessBilling #FastTrackMedicalBilling #AcceleratedRevenueFlow #EfficientCoding #QuickPayments

Beyond the well-known HIPAA regulations, there are numerous other compliance requirements to consider that affect medical claims processing. Achieving compliance is no easy task, but with diligent oversight, risks can be controlled. Find out more about the top strategies for attaining full compliance, tackling common hurdles, and benefits of an adherent claims process in our latest blog. ? #HealthcareCompliance #MedicalBilling #RCM #RevenueCycle #RevenueCycleManagement