What Clean Claim Rate Should a Dermatology Billing Partner Actually Guarantee You?

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Choosing a dermatology billing partner based only on a promised clean claim rate can be misleading. A billing company may tell you that it maintains a 95%, 97%, or even 99% clean claim rate. But before accepting that number, you need to know how the rate is measured, what claims are included, and whether those clean claims are actually being paid correctly . For dermatology practices, this matters because a claim can pass an initial billing check and still face problems related to medical necessity, modifiers, procedure coding, payer policies, or underpayment. A clean claim rate should therefore be viewed as one part of the revenue cycle, not the entire performance picture. What Clean Claim Rate Should a Dermatology Billing Partner Guarantee? A reasonable contract target is 97% or higher , provided the billing partner clearly defines the metric and measures it consistently at the payer level. The percentage itself, however, is only part of the agreement. A dermatology practice should a...
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MPFS Strengthening Behavioral Health Billing for 2023

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CY 2023 Medicare Physician Fee Schedule (MPFS)

The Centers for Medicare and Medicaid Services (CMS) on Nov. 1, 2022, released the final 2023 Medicare Physician Fee Schedule (MPFS), addressing Medicare payment and quality provisions in the coming year. The U.S. Department of Health and Human Services (HHS) through its Centers for Medicare & Medicaid Services (CMS) is expanding access to behavioral health care. The Calendar Year 2023 Physician Fee Schedule (PFS) final rule announced today also promotes innovation and coordinated care in the Medicare program through Accountable Care Organizations (ACOs). This rule directly supports the Administration’s commitment to strengthening behavioral health, which the President outlined in his first State of the Union Address, and the comprehensive strategy to tackle the nation’s mental health crisis. In this article, we shared key behavioral health billing updates from CY 2023 MPFS which would act as a baseline for your behavioral health billing for 2023.

MPFS Strengthening Behavioral Health Billing for 2023

In light of the current needs among Medicare beneficiaries for improved access to behavioral health services, CMS has considered regulatory revisions that may help to reduce existing barriers and make greater use of the services of behavioral health professionals, such as licensed professional counselors (LPCs) and Licensed Marriage and Family Therapists (LMFTs). Therefore, CMS is finalizing the proposal to add an exception to the direct supervision requirement under our ‘incident to’ regulation at 42 CFR 410.26 to allow behavioral health services to be provided under the general supervision of a physician or non-physician practitioner (NPP), rather than under direct supervision, when these services or supplies are furnished by auxiliary personnel, such as LPCs and LMFTs, incident to the services of a physician (or NPP).

To know more about MPFS Strengthening Behavioral Health Billing for 2023 click here: http://bit.ly/3EpZTry Contact us at info@medicalbillersandcoders.com/ 888-357-3226.


Location: United States

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