Billing / Collections / Coding
The Centers for Medicare and Medicaid Services (CMS) released its final rule that includes timelines for when the patient is entitled to receive a GFE. It can depend greatly upon the patient's insurance status, the provider's insurance network status, and the type of care and location of the service.
In today’s ever-changing healthcare environment, it’s important to have resources to keep you up to date on issues affecting patient care and practice revenue. CAP is here to support all members with vital updates.
CAP’s My Practice program has received several calls from CAP members about COVID vaccine reimbursement and denials, as there has been much confusion on how to bill. As if the pandemic hasn’t been stressful enough due to income loss and other challenges, billing has become even more difficult to navigate.
Over the past decade, the healthcare industry has gone through significant change. With value-based care, physicians are reimbursed based on quality rather than volume. The goal is to support patients at their highest possible level of wellness rather than wait to provide care until they get sick, which is often more complex and expensive.
The Court of Appeal has told a health plan, in effect, “not so fast” after the plan refused to consider a surgeon’s attempt to correct an initial coding error after an alleged emergency surgery.