The Stone Oak Ophthalmology Center, a three-provider practice based in San Antonio, Texas, came on board with PMRG as their billing service provider in 2019.

After 3 years of solid work and a strong partnership with PMRG, Dr. Allison Young, the practice founder, was drawn away by the promise of having their EPM, EHR, and billing service all under one company.

It didn’t take Dr. Young long to realize that she had made a mistake.

This article explains when to use VSP as a secondary or tertiary insurance; how to bill it; and how to communicate this benefit effectively to patients.

Are you thinking about switching things up and changing your practice management (PM) system, your EMR or both? If you are, you’re not alone! It is important to understand the ramifications of doing so before you get started.

Understanding your payer contracts can affect denial of payment as well as the amount and timeliness of reimbursement. Learn more about the provisions you should consider when reviewing potential new or existing payer contracts.

Many of you may be aware of the CMS evaluation and management add-on code that was introduced in January of this year. According to CMS, “G2211 captures the inherent complexity of the visit that’s derived from the longitudinal nature of the practitioner and patient relationship”.

Social Determinants of Health (SDoH) are economic or social conditions in the environment that can affect individuals’ health and quality-of-life outcomes.

Consolidated billing was established by the Centers for Medicare & Medicare Services (CMS) in 1998 to help eliminate duplicate billings for services rendered to SNF residents by multiple providers. With consolidated billing, an SNF receives a basic per diem rate per level of care for each resident.

There are times when care is not covered by Medicare because they deem the service not medically necessary. In these circumstances, it is vital to make sure that you communicate the likelihood that the service will not be paid for by Medicare and give your patient the option to receive these services but pay for them out-of-pocket.
This communication is called an Advanced Beneficiary Notice of Non-Coverage, or ABN.

National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) are created by the Centers for Medicare & Medicaid Services (CMS.) They apply to all Medicare providers to establish how a service will be covered; what criteria is required to establish medical necessity; and what documentation requirements there are for the service.

Time management is the organization of one’s time and activities. Time-management skills are important for health care professionals who must perform a multitude of different tasks throughout the day.

Collecting patient balances at the time of service is a key step in your revenue cycle. If your office does not currently have policies and procedures in place for collecting from your patient at the time of the visit, it can be a challenge to implement.

Although it may seem the easiest way to be “compliant, if your compliance plan is not personalized for your practice, you could face scrutiny from the OIG.