Medical Billing Blogs

  Fee-for-Service (FFS) medical billing is a reimbursement model in healthcare where providers receive payment for each service or procedure they perform. Under this system, healthcare providers bill insurance companies, government programs, or patients directly for individual services rendered, and they are reimbursed according to a predetermined fee schedule. Each service, such as an office visit, diagnostic test, or surgical procedure, has a specific billing code associated with it, and providers submit claims for each service provided. The reimbursement amount is typically determined by factors such as the complexity of the service, geographic location, and negotiated rates with payers. FFS billing contrasts with other reimbursement models, such as capitation or bundled payments, where providers receive a fixed payment per patient or episode of care, regardless of the number or type of services provided. Fee-For-Services vs. Value-Based Care (VBC) Basis of Difference Outcomes...

  The skilled nursing facility (SNF) landscape continues to evolve, and 2024 is no exception. New regulations and reimbursement rule modifications can significantly impact your facility’s billing practices. Mastering these regulatory shifts changes in 2024 is crucial for ensuring accurate claims submission, minimizing denials, and maximizing revenue. Understanding the Impact of New Billing Codes A key regulatory shifts in 2024 involves the introduction of  new billing codes for SNFs . These codes aim to enhance specificity and accuracy in billing for services rendered to residents. Here’s how this can affect your facility: Improved Documentation and Coding Accuracy The new codes necessitate a more granular approach to documentation. Clinicians must meticulously record details of services provided to ensure proper code selection. This translates to fewer denials due to coding errors and ultimately, smoother cash flow. Potential for Increased Revenue More specific codes can lead...

  Durable medical equipment (DME) plays a vital role in improving patient outcomes and quality of life. From CPAP machines for sleep apnea to wheelchairs for mobility assistance, DME allows patients to manage chronic conditions and maintain independence. However, navigating the complexities of DME billing can be a significant challenge for healthcare providers. Here’s where 24/7 Medical Billing Services steps in. We understand the intricacies of DME billing and the unique challenges faced by DME suppliers. Our round-the-clock support ensures your practice receives timely and accurate reimbursements, freeing you to focus on delivering exceptional patient care. DME Billing Complexities DME billing adheres to a strict set of regulations established by the Centers for Medicare & Medicaid Services (CMS). These regulations include specific coding requirements,  DME prior authorization  processes, and documentation standards. Failure to comply with these regulations can resu...

Critical care medicine specialists play a pivotal role in diagnosing and treating a wide array of severe illnesses. Given the complexity of caring for critically ill patients, a multidisciplinary team approach is essential. However, billing for critical care services involves dealing with complex rules and regulations to ensure accurate reporting on claims. As a critical care provider, staying abreast of these guidelines is paramount to guaranteeing proper reimbursement and conveying the intensity of care provided. Scope of Critical Care Services Medicare’s guidelines now align with the Current Procedural Terminology (CPT) definition of critical care, emphasizing the care of critically ill or injured patients with acute impairment of vital organ systems. This care demands complex decision-making to address organ failure and prevent life-threatening deterioration. Notably, critical care services may be administered by both physicians and non-physician practitioners (NPPs), such as nur...