Healthcare News

Changes in pharmacy enrollment requirements have significant implications for providers, particularly in states like New York and potentially others. These changes necessitate a shift from simply managing a registered Medicaid pharmacy to meeting the requirements of fee-for-service p...

For business entrepreneurs venturing into the world of durable medical supplies, a common dilemma arises: Should you buy an existing DME (Durable Medical Equipment) company or start a brand-new one from scratch? The answer to this question is not one-size-fits-all and depends on vari...

Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) services have become essential components of patient care and revenue generation. However, the path to reimbursement for these services is not always straightforward. Each insurance company has its unique set of requiremen...

Medicare enrollment is a fundamental step for healthcare providers looking to serve the senior population effectively. However, the process can seem daunting, with numerous requirements and steps to follow. In this article, we break down the basic prerequisites for Medicare enrollmen...

For any medical practitioner seeking to enhance their practice and ensure seamless operations, mastering the realms of billing and credentialing is an absolute necessity. These two pillars form the foundation of a successful medical business, demanding a comprehensive understanding of
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We need hardly say that the process of claim submission holds significant weight. Among the various methods of submitting claims, paper-based submissions continue to play a crucial role in facilitating efficient communication between healthcare providers and payers. However, to ensur...

Navigating patient coverage is a cornerstone of effective healthcare administration. You need to know that some Oxford plan members, patients who are members of UnitedHealthcare Choice Plus or UnitedHealthcare Core are in network with your practice. To ensure seamless care and effici...

Providers often find themselves grappling with policy changes and evolving regulations. The recent policy of non-renewals by MetroPlus has caused waves among New York providers, leaving them concerned about the future of their affiliations. Amid this uncertainty, WCH Consulting steps...

The challenges faced by physical therapists seeking a foothold in the insurance industry are becoming increasingly apparent. As new waves of graduated physical therapist students step into the arena, the influx of fresh talent is both promising and challenging, amplifying the competi...

In today's complex healthcare landscape, selecting the best Independent Practice Association (IPA) for your medical practice can be a daunting task. Understanding the intricacies of IPA rates and billing can often lead to uncertainties about the IPA's functions and potential future o...

In recent times, the buzz around compact state licensure has been growing louder within the community. If you are unfamiliar with this concept, it's time to understand what it entails and how it can be a game-changer in your career. Compact states are a group of states that have come...

In today's interconnected world, opportunities for doctors to practice in different states are more accessible than ever before. The prospect of reaching patients beyond state borders can be enticing, offering additional revenue streams and a chance to expand one's reach as a healthc...

As of March 1, 2023, Carelon has stepped into the spotlight as a new processing vendor for mental health, taking over from Beacon. With this transition, providers in the industry must exercise caution and vigilance in reviewing their reimbursement to ensure they are not being underpa...

Billing and credentialing are two critical components that go hand in hand. Properly aligning these processes can lead to significant opportunities for healthcare providers. By partnering with a professional company that specializes in billing and credentialing, providers can unlock ...

Regional contracts play a pivotal role in shaping market dynamics. With major players such as Aetna, Cigna, Blue Cross, and United Healthcare dominating the industry, their presence is felt in every state across the nation. While they may appear in every state, it's important to note...