RMK HOLDINGS INC. specializes in fulfilling the resource gap after the medical claim is billed.
A huge threat to receiving timely healthcare reimbursements are the dreaded claim rejections and claim denials. In addition, these are two phrases often used interchangeably in healthcare billing circles that shouldn't be because they hold two different meanings. Understand the difference and adjust your workflow to reduce double work.
Some sobering numbers surfaced from a 2016 Black Book Market research survey. They surveyed 2,000 independent physicians and 200 hospital-based physicians. The results suggested that 90% or nine in ten small, independent practices are financially and technically challenged to implement value-driven care for patients.
The Centers for Medicare & Medicaid Services (CMS) decided to reimburse providers as a monthly fee for remote patient monitoring (RPM) billed under CPT code 99091. The services are defined as
A HIPAA guidance release in January notes that providers can share information with the loved ones of patients even if they are not seen as relatives under current laws. An accompanying FAQ elaborated on the update stating that it is generally permissible to allow disclosures to a loved one not married to the patient or other recognized relatives. In these cases, the same circumstances and conditions apply if the individual was a spouse.
Continuous changes in health insurance reimbursement guidelines result in an often complex medical billing scenario. This is unlikely to change. Evaluate your intake to charge to claim submission workflow and follow the basic best practices to target preventable denials and maximize reimbursement on the first pass.
The flexibility offered during the transition to ICD-10 coding disappeared as of October 1, 2016. Now, all providers need to precisely reflect clinical documentation per the coding guidelines and assign codes to the highest degree of coding specificity. A lack of documentation supporting the code can lead to the dreaded claim denials.