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Key Differences Between Inpatient Coding and Outpatient Coding

One of the most importance considerations during the medical billing and coding process is to choose whether the patient is an inpatient or an outpatient.  Based on the choice, the medical codes associated differ.  At times, inexperienced medical coders may unintentionally misrepresent the patient status which could result in denied claims and even accusations of fraud.

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Population Health Strategies

Population Health Management Strategies

The basic goal of population health management is to manage the health of a defined population optimally by providing the right intervention(s) to the right people at the right time. Well-designed population health tools when implemented thoroughly, benefits the patient, makes workflow easier for the provider and keeps costs low for health systems and payers.

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MACRA

50% Practitioners not prepared for MACRA

It has been more than two years since Congress voted to enact the Medicare Access and CHIP Reauthorization Act of 2015 and subsequent deadlines for various aspects of the law were issued by the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS). And yet, surveys conducted earlier this year and a few conducted more recently indicate that a large number of healthcare professionals are not familiar with the Medicare Access and CHIP Reauthorization Act (MACRA).

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Provider Credentialing

Efficient Provider Credentialing

To provide the best possible healthcare to your patients, it is important that your healthcare providers are up to the task. But, how can you ensure that the healthcare providers you hire are competent and qualified for the job. Provider credentialing is the best way to compare, evaluate and verify the qualifications and competency of the healthcare providers that you are hiring.

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HCC Coding Tips

HCC Coding Tips – The Importance of M.E.A.T.

What is HCC Coding/What does HCC Stand for

HCC scores have been used since 2004 by Medicare to adjust payments based on the risk level of the enrollee. This has resulted in Medicare paying a higher monthly capitation fee for patients with higher HCC scores as these patients require more resources and disease intervention.

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Medical Billing Cardiology

MIPS for Cardiologists

The new MACRA implementation has brought about nothing but chaos and confusion among medical practitioners, and more so for cardiovascular specialists. MIPS (Merit Based Incentive Payment System) is the new payment model that is geared towards a value-based payment rather than the existing service based model. This shift comes with a number of changes that a medical practitioner has to incorporate into his practice in order to ensure that the revenue is not amiss.

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Adjusted Collection Rate

Understanding Net Collection Rates

Understanding net collection rates will help you to gain a better understanding of how much money that is owed to your practice is collected. Calculating your collection rate is quite simple, but it offers an excellent understanding of where your business stands and how you can improve it through medical billing operations.

Calculating your Net Collection Rate

The net collection rate holds a barometer to the health of your medical practice.

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Top MACRA Challenges

Top MACRA Challenges for Clinicians

MACRA replaces the service based payment with the value-based payment system. This change has brought about a number of challenges for the physicians, which they have to overcome in order to continue to have a hassle-free practice. Some of the most common challenges that a physician has to overcome when dealing with MACRA are as follows:

Staying aware of the MACRA and MIPS details

Despite having come into practice in 2015,

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MACRA MIPS

CMS: 800,000 Physicians Exempted from MACRA MIPS Reporting

CMS seems to have done a complete turn-around since its 2016 release of mandating MACRA participation, especially for the Advanced Alternative Payment Models (APMs). As of this year, over 800,000 clinicians are not expected to comply with the MACRA MIPS reporting, which could have potentially saved them million in compliance costs.

Who are exempt,

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