Medical Billing

Medicare Part D New Update - Medicare Part D insulin coverage changes The cost of a one-month supply of each Part D-covered insulin is capped at $35, and you don’t have to pay a deductible For insulin. This applies to everyone who takes insulin, even someone who gets Extra Help. If someone gets a 60- or 90-day supply of insulin, costs can't be more than $35 for each month's supply of each covered insulin. For example, if someone gets a 60-day supply of Part D-covered insulin, you'll generally pay no more than $70.  Other questions about insulin coverage?  Plans have until the end of March 2023 to update their systems to reflect the $35 cap on insulin, which means you might be charged a higher amount during this time when you fill a prescription for insulin. If you pay more than $35 for a month’s supply of a covered insulin product in January and/or February 2023, your plan must reimburse you within 30 calendar days for any amount you paid above the $35 cap. Conta...

Quality control (QC) is an important process in any industry especially in US Healthcare, as it helps to ensure RCM and Medical Billing services meet certain standards of quality and reliability to end customers. There are several tools and techniques that can be used to support QC efforts, and in this blog, we will explore seven of the most common and effective QC tools: Flowcharts: Flowcharts are graphical representations of a process or system, showing the flow of steps or activities from start to finish. Flowcharts can be used to identify bottlenecks, inefficiencies, or potential problems in a process, and to suggest ways to improve it. Check sheets: Check sheets are simple lists or tables that can be used to track and record data or observations about a process or product. Check sheets can be used to identify patterns or trends in the data and to identify areas for improvement. Control charts: Control charts are graphs that plot data ...

Value-based care and patient-centered billing are two important trends in the healthcare industry that are transforming the way that care is delivered and paid for. In this blog post, we will explore the concept of value-based care and how it is related to patient-centered billing, as well as the potential benefits and challenges of these approaches. What is value-based care? Value-based care is a model of healthcare delivery that focuses on improving the quality of care and patient outcomes, rather than simply providing more services. In a value-based care system, providers are rewarded for meeting specific performance goals, such as reducing hospital readmissions or improving patient satisfaction. This approach aims to reduce waste and unnecessary costs, while also ensuring that patients receive the right care at the right time. How is value-based care related to patient-centered billing? Patient-centered billing is a way of presenting charges and payments to patients in a wa...

 2023 US Holiday List Overview of the main federal holidays in the United States for 2023 Brief mention of some state and local holidays that may be celebrated in different parts of the country II. New Year's Day (January 1) History and traditions of New Year's Day celebrations Public and private observances of the holiday III. Martin Luther King Jr. Day (Third Monday in January) Biography and legacy of Martin Luther King Jr. History and significance of the holiday Activities and events held in honor of the civil rights leader IV. Presidents' Day (Third Monday in February) History and origin of the holiday Tribute to all past presidents of the United States Sales and other commercial activities associated with Presidents' Day V. Memorial Day (Last Monday in May) History and traditions of Memorial Day Honor and remembrance of fallen soldiers and veterans Parad...

Medicare Part B Premium and Deductible Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.  Each year the Medicare Part B premium, deductible, and coinsurance rates are determined according to the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $164.90 for 2023, a decrease of $5.20 from $170.10 in 2022. The annual deductible for all Medicare Part B beneficiaries is $226 in 2023 , a decrease of $7 from the annual deductible of $233 in 2022.

 RCM Q&A 3 Duplicate Denial: Top RCM Technical Questions and Answers with Sample Notes Question: How do you work on – Duplicate Denial Answer : Step1: The status of a claim can be found on the insurance company's website, Through EOB, Correspondence,. Step2: Check-in the billing system, if you have any duplicate denial in the system. If yes check with the coding team. If it's a real duplicate adjust off the balance. If no Step3: Call the insurance company and ask the rep May I know the claim received and denied date and the Original claim status Step4: If the original claim is denied go by the denied scenario If it is paid go by the paid scenario and if it is in-process then go by the in-process scenario Step5: May I know the original and current claim#, Could you please send the copy of EOB( duplicate copy) Step 6: May I know the claim# and reference # If you need to answer all the above-mentioned steps with the interviewer   Sample Notes : Claim # Dos...

RCM Q&A 2: Top RCM Technical Questions and Answers with Sample Notes  Question: How do you work on - Claim Denied for Authorization Same Question instead of denial Interviewer can ask the question like Missing/invalid/Authorization/Notification/Pre-certification etc.,   Answer : Step1 : The status of a claim can be found on the insurance company's website; but, for missing authorization denial scenarios, you must contact the insurance company for more information. Step2 : Provide Physician and Claim related information with the rep Step3 : Ask rep May I know the claim received and denied date Step4 : Ask why you required authorization for this service/cpt code and do they see any authorization on the file for another hospital claim Step5: If yes Step6: Could you please send the claim back for reprocess with that authorization and check the authorization effective and end date Step7: If No Step8: Can we get the retro authorization for this service Step9: If Yes Step ...