Denials management and appeals are the two most underestimated processes in rheumatology offices. Most practices lose thousands of dollars every year because they are not following up or writing off denied claims correctly.
American College of Rheumatology (ACR) on Capitol Hill
“By tomorrow night, there will be so many more people on Capitol Hill who know—and are sensitive to—rheumatology and the issues that impact you and your patients. There is no substitute for what you are doing,” says Martha M. Kendrick, a partner at Patton Boggs, LLP, the ACR’s lobbying firm. This is what she told the physician, health professional, and patient participants of the ACR’s 2008 “Advocates for Arthritis” advocacy event—termed a fly-in—before they took their personal stories to the lawmakers on Capitol Hill.
Aloha from the 2007 AMA House of Delegates Interim Meeting
The 2007 AMA House of Delegates interim meeting was held November 10–13 in Honolulu. The ACR was represented by its delegate, Melvin Britton, MD, and alternate delegate, Gary Bryant, MD.
How Medically Unlikely Edits Affect a Practice
Medically unlikely edits (MUEs), formally known as medically unbelievable edits, took effect with the Centers for Medicare & Medicaid Services (CMS) on January 2, 2007. The function of MUEs is to detect and deny unlikely CMS claims on a pre-payment basis with the intention of improving Medicare’s payment process.
The Symptoms or the Disease
Where should we focus?
Coding Corner Answer: January 2008
January’s Coding Answer
Missed Appointments Equal Missed Revenue
What do you do when a patient misses an appointment? While an opening in the schedule might seem like a good time for staff to take a break or catch up on their to-do lists, missed appointments are a growing problem in physician practices. With today’s need to maximize every dollar, practices should take a closer look at the effect these missed appointments have on their bottom lines.
Clean Claims Equal Prompt Payment
Submitting a clean Medicare reimbursement claim the first time can save your practice thousands of dollars each year. The Centers for Medicare and Medicaid Services (CMS) defines a clean claim as “a submitted patient claim form without any defect or need for substantiation.”
Fraud and Abuse: What’s the Difference?
Each year, fraud and abuse cost the Medicare and Medicaid programs billions of dollars. What is the difference between fraud and abuse? The Centers for Medicare & Medicaid Services define fraud and abuse as two different offenses…
Profiling Providers: Is Your Practice Ready?
Medicare may start profiling physicians as soon as mid 2008. The Government Accountability Office (GAO) recommended that the Centers for Medicare & Medicaid Services (CMS) develop a profiling system to identify physicians with inefficient practice patterns. At a House Ways and Means Subcommittee on Health hearing, Herbert Kuhn, acting deputy administrator of the CMS, said that identifying inefficient physicians, or “profiling,” would involve comparing the number of tests ordered by a physician for certain types of patients with the number ordered by colleagues in cases with the same outcome.