Mastering Time-Based Anesthesia Billing: A Guide to Boost Accuracy and Revenue

-
Image
  Anesthesia billing is a unique and intricate component of medical billing that differs significantly from other specialties. Unlike procedures billed on a per-service basis, anesthesia is often billed based on the duration of the service—making time-based billing a critical factor in accurate reimbursement. Let’s break down what time-based anesthesia billing entails and how practices can optimize their billing processes to avoid costly errors and delays. What is Time-Based Anesthesia Billing? Time-based anesthesia billing involves calculating charges based on the total time the anesthesiologist spends with a patient. This typically includes: Preoperative preparation Administration and maintenance of anesthesia Post-anesthesia care until the patient is no longer under the anesthesiologist’s care The billing formula generally looks like this: Total Units = Base Units + Time Units + Modifying Units Base Units : Determined by the specific surgical procedure perfor...
Post a Comment

Medicare Rules Contributing to a Fraud Free DME Billing!

-

 

medicarerulescontributingtoafraudfreedmebilling.jpg

Long-standing concerns in DME (Durable Medical Equipment) known for unquestionable billing practices, led the government to take action for tackling fraud in the insurance industry. Medicare, the nation’s largest health insurance program, regulates the billing structure of the maximum number of healthcare providers. Due to its highly fragmented nature, Medicare is prone to widespread fraud thereby rising healthcare costs, taxes, and premiums. DME billing is the process of submitting and receiving payment for a claim from the insurance company.

Medicare pays for services given to the severely sick/disabled at home such as wheelchairs, arthritis kits, etc. But many DME companies supply cheap or bad quality equipment at good quality equipment rates to make profits or sometimes bill Medicare for equipment never provided. To crack down, on this fraud, the Centers for Medicare & Medicaid Services (CMS) issued new rules catering toward reducing needless consumption and aberrant billing amongst DME and supply companies.

According to medpagetoday.com, “Specific durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that are most commonly and unnecessarily overused will be subject to an updated authorization process that will, for some items, require prior approval before Medicare will pay for them. Not involving any new documentation, this prior authorization will oblige companies to validate relevant coverage, coding, and clinical documentation concerns before a beneficiary receive a product and before a Medicare benefit claim is submitted. Modifying the process in this way will prevent beneficiaries from being forced to pay for items that aren’t covered by Medicare.”

CMS also created a master list containing 135 items that are subjected to prior authorization before the equipment is provided to the beneficiary. It should have an average fee of USD 1000 or greater or a rental fee of USD 100 or greater.  Also, CMS highlighted a 3-year prior authorization demonstration project for power mobility devices (PMD – wheelchairs, scooters, etc.) to reduce expenditures.

To know more about the Medicare Rules Contributing to a Fraud Free DME Billing, click here: https://bit.ly/40KyatR Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

Comments

Post a Comment

Popular posts from this blog

Streamlining Telehealth Billing: What Features Do Physicians Need in 2024?

-
Image
With telehealth rapidly becoming the new normal, physicians are facing a wave of new challenges, especially when it comes to billing. Navigating insurance complexities and code changes becomes even trickier in the virtual setting. So, what features are essential in a billing system to ensure smooth telehealth claim processing in 2024? 1. Automated Telehealth Code Recognition: Forget manually sifting through codes! Look for a system that automatically recognizes telehealth-specific codes based on session types and documentation. This saves time and minimizes the risk of incorrect coding. 2. Real-time Eligibility and Prior Authorization Verification: Streamline the process by verifying patient benefits and prior authorizations in real-time during the telehealth encounter. This helps avoid claim denials and ensures prompt reimbursements. 3. Secure Patient Data Integration: Seamless integration with telehealth platforms and electronic health records (EHRs) is crucial. This minimizes ...
Read more

How to Reduce Days in A/R with Smart Denial Management Strategies

-
Image
 Timely reimbursement is the lifeblood of a financially healthy medical practice. Yet, increasing Days in Accounts Receivable (A/R) continues to be one of the most pressing revenue cycle issues for healthcare providers. One of the major culprits behind this issue? Denials. In this blog, we explore how strategic denial management not only reduces days in A/R but also improves cash flow and strengthens your bottom line. Understanding Days in A/R Days in A/R refers to the average number of days it takes for a practice to collect payments due after services have been provided. Industry benchmarks typically suggest keeping A/R days under 35. Anything higher signals inefficiencies - and likely unresolved denials. How Claim Denials Affect A/R Denied claims delay payments and increase administrative burden. Without an effective process to identify, appeal, and correct them, your A/R days will climb - and revenue will suffer. Top causes of denials include: Missing or incorrect ...
Read more

What are the most common mistakes In-House people make with medical bills?

-
Image
Let's be honest, medical bills can tangle anyone's brain, even those working inside hospitals and clinics! Folks like doctors' office assistants and hospital staff handle internal billing daily, but even they can stumble into common mistakes that leave patients grumpy and paperwork piled high. Let's shine a light on these hiccups and equip you with some simple tips to navigate the world of bills with ease, making everyone's day a little brighter! 1.        Blind Trust in Automation: Automating billing processes streamlines workflow, but relying solely on technology can be a trap. Errors can slip through the cracks, leading to inaccurate bills and unhappy patients. 2.        Misunderstanding Insurance Lingo: Medical jargon and insurance codes can feel like a foreign language. In-house staff who aren't familiar with the nuances can interpret coverage incorrectly, leading to mismatched bills and frustrated patients. 3....
Read more