Billing and Collections

Best practice tips and information related to billing and collections.

 

Master Evaluation and Management Coding Guidelines
Evaluation and management (E/M) encounters remain the most challenging coding areas for physicians and coders alike. If your coding patterns make you an outlier in your specialty and locality, it can be a red flag and may trigger an... Read More

Use the Complaint Process to Your Advantage
As it has become increasingly more administratively difficult to obtain payment from payers, it is essential to know about and utilize all resources available to you to obtain claims payment. If a payer is violating state or federal rules and regulations, it is important to lodge a complaint with the appropriate... Read more

Using Front-End Claim Edits
Claims rejections and denials are on the rise significantly impeding cash flow and increasing the cost of doing business. The MGMA estimates the cost of reworking a rejected claim is $25 and estimates that 50- 65% of denied claims are never... Read More

Bill correctly the first time - use our Billing and Payers page for resources and tools
Resource for accurate billing to reduce claims denials and receive appropriate payment. An integral part of running a medical practice is billing for health care services that are provided. Below, you will find many helpful guide, tools, and information to assist you in navigating various billing requirements to... Read More

Understand the Prompt Pay Rules 
State and federal laws often provide provisions for penalties and/or interest to be paid to providers when claims are not paid timely according to established payment deadlines. When claims are not paid timely, be sure to always press the payer to pay... Read More

Missed Opportunities - Overlooked Codes to Increase Revenue
It’s a common complaint heard among primary care physicians: Evaluation and management (E/M) codes don’t adequately capture the time, skill, and resources necessary to plan and coordinate care for patients with complex medical needs. Although new... Read More


 

How to Submit Your Best Practices
HCMS is asking physicians and their staff to send us their 'best practices' to post for the benefit of all members. Click here to submit.