Medical Billing

What Payment Integrity Means for Providers, How to Avoid Claim Issues

by Jacqueline LaPointe

Healthcare providers are constantly running into payment integrity tools payers put in place to ensure proper payment. But payment integrity is also crucial for providers if they want accurate, complete, and timely reimbursement. Of the...

About a Quarter of Residents in 18 States Have Medical Debt

by Jacqueline LaPointe

Medical debt is a problem for Americans, with as many as a quarter of residents in 18 states having medical debt in collections, according to a new Commonwealth Fund report. The states with the...

Back to the Basics, Other Payment Integrity Strategies Post-PHE

by Jacqueline LaPointe

After an unprecedented three years, it’s time to return to the basics, according to Jordan Kearney, partner at Hooper, Lundy, and Bookman and founder of the firm’s Medicare Audits and Appeals Practice Group. By that, she means...

Eye Specialists Pay $17M to Resolve False Claims Act Violations

by Victoria Bailey

SouthEast Eye Specialists, SouthEast Eye Surgery Center, and the Eye Surgery Center of Chattanooga (SEES) must pay $17 million to the United States and Tennessee to resolve allegations that they...

Independent Dispute Resolution Case Load 14X More Than Expected

by Jacqueline LaPointe

Nearly a year after the federal government launched the independent dispute resolution (IDR) process under the No Surprises Act, over 330,000 balance billing disputes have been filed, nearly 14 times...

CFPB Report Identifies Pitfalls of Medical Credit Cards, Loans

by Jacqueline LaPointe

In the age of high deductibles, providers are increasingly turning to financial institutions and fintech companies to offer medical credit cards and installment loans to their patients. However, a new...

Major Credit Bureaus Remove Medical Debt Collections Under $500

by Jacqueline LaPointe

Three major credit bureaus are giving consumers a break when it comes to medical debt. Equifax, Experian, and TransUnion jointly announced yesterday that any medical debt collection with an initial...

Two-Thirds of Patients Have Never Challenged a Medical Bill’s Accuracy

by Victoria Bailey

Nearly two-thirds of patients have never challenged a medical bill, but among those who have, most charges were reduced or removed, according to a survey conducted by AKASA on behalf of YouGov. The...

CMS Resumes IDR Payment Determinations Under No Surprises Act

by Jacqueline LaPointe

CMS has instructed certified independent dispute resolution (IDR) entities to resume payment determinations for disputes involving items or services furnished on or after Oct. 25, 2022, according to...

Past-Due Medical Debt Impacts Over 1 in 7 Adults

by Jacqueline LaPointe

More than one in seven nonelderly adults live in families with past-due medical debt, according to the Urban Institute in a new report. The report also finds that medical debt particularly impacts...

How E/M Payment Policy Changes Impacted Physician Reimbursement

by Victoria Bailey

Evaluation and management (E/M) payment policy changes implemented in 2021 resulted in higher Medicare reimbursement for most physicians but only led to a modest decrease in the payment gap between...

Providers are Increasingly Billing Outpatient Visits at Higher Levels

by Victoria Bailey

Outpatient visits are being billed at higher levels, leading to increased healthcare spending and concerns about upcoding, a Peterson-KFF Health System Tracker found. Healthcare providers can bill...

Medical Billing Companies Spill About Outsourcing Operations

by Jacqueline LaPointe

Nearly two-thirds of medical billing companies have a rising positive outlook about the current state of the revenue cycle outsourcing industry, according to a recent survey from Tebra. The practice...

Lessons from the NSA’s Independent Dispute Resolution (IDR) Process

by Jacqueline LaPointe

Nearly a year since the federal government launched the independent dispute resolution (IDR) process, Becky Greenfield, partner at Wolfe Pincavage, has learned a few things about the No Surprises Act (NSA) and out-of-network claim...

TX Physicians Win No Surprises Act Rule Court Case

by Jacqueline LaPointe

A federal judge has ruled in favor of the Texas Medical Association’s (TMA’s) challenge of a No Surprises Act rule released by HHS to flesh out the independent dispute resolution (IDR)...

People Have Less Trouble Paying Medical Bills, But Concerns Remain

by Jacqueline LaPointe

Paying medical bills has gotten a little easier for patients, according to a new report from HHS. The report released by the Centers for Disease Control and Prevention (CDC) found that the percentage...

Consumers are Frustrated with Healthcare Billing Correction Process

by Victoria Bailey

Consumers are frustrated with the healthcare billing process and face challenges when it comes to identifying and solving billing errors, according to a survey from Zelis and Hanover Research. The...

Federal IDR Process Faces More Disputes Than Expected, Backlog Growing

by Jacqueline LaPointe

Payers and providers are utilizing the independent dispute resolution (IDR) process far more than the government expected to resolve disagreements about payment for items and services covered by the...