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Articles tagged with "Reimbursement"

How Medically Unlikely Edits Affect a Practice

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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.

Mind Your Accounts Receivable

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Over time, one would expect financial management of a medical practice to become more streamlined and simple. With the abundance of electronic tools, software programs, and the Internet, you can find assistance and problem-solving strategies for economic efficiency. In the rush to take advantage of these support tools, basic facets of financial management, such as billing and collection, have fallen by the wayside.

Missed Appointments Equal Missed Revenue

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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

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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.”

Plan for Success in 2008

David A. Fox, MD  |  

We’re ready for the rewards and challenges of the coming year

National HMO Class-Action Case Settled

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The latest development in the healthcare class-action settlement will affect approximately 900,000 physicians (and some major state medical societies) who may be eligible to receive compensation from the settlement – as long as they file a claim. The case has been called “historic” by those representing both physicians and insurance companies.

Be Aware of New Waived Tests

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Keeping current on changes to laboratory certifications for common lab tests can save your practice time—and money. Since the passage of the Clinical Laboratory Improvement Amendments (CLIA) in 1988, all health-assessment laboratory tests are ranked for complexity, and their complexity dictates which labs can process Centers for Medicare and Medicaid Services (CMS)–reimbursed tests. In accordance with CLIA, each laboratory facility must register with CMS to receive a CLIA certification. There are five certifications, each with differing degrees of complexity, listed from least to most complex: Certificate of Waiver, Certificate of Provider-Performed Microscopy Procedures, Certificate of Registration, Certificate of Compliance, and the Certificate of Accreditation.

ACR Unites with AMA to Correct SGR

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Fair Medicare reimbursement is of great concern of physicians today. During the past few years, the SGR has called for damaging cuts to physician payments. Each year, however, Congress has placed a temporary fix on the scheduled cuts.