Healthcare News

If prosecutors find that providers disregarded PIR (protected information rules) in a way that warrants more punishment than fines and penalties - the doctor faces up to a year in prison on charges of violating the HIPPA rules. It does not happen very often, but you should concern about getting into...

Treating patients in the NYS workers’ compensation system thanks to the recent increases to medical fee schedules and adoption of the CMS-1500 universal medical billing form, more in line with conventional health care now. Nevertheless, some differences remain in the treatment of such patients...

Medical Documentation: What You Need To Know About Recordkeeping, Amendments, and Delayed EntriesAll services are expected to be documented in the medical record at the time they are rendered. If certain entries related to provided services are not properly documented, those entries will need to be ...

OIG Special Fraud Alert: Arrangements with Telemedicine CompaniesThe Office of Inspector General has discovered a massive fraud scheme involving healthcare practitioners and telemedicine companies. According to a recent report, virtual health providers have been encouraging practitioners to issue or...

None of the initial claim denials are irreversible. If your claim gets denied or underpaid, there is always an option to overturn the original decision. Healthcare providers who believe that the payment for their services has been denied incorrectly may initiate a reconsideration process with the pa...

Nurse practitioners (NP) are one of the most important for both private medical practices and large hospitals. As a health service provider, you should make sure that you properly select and hire your next nurse practitioner. It would be helpful to plan and define the following before you even begin...

Sometimes there is a need to launch enrollment processes with HMO plans while your Medicaid fee-for-service application is still pending. Unfortunately, our experience shows that delays in application processing for Medicaid enrollment are quite frequent regardless of a provider’s state. To se...

Healthcare providers who perform & bill laboratory tests on Medicare patients are subject to new CLIA-related regulations in 2022. Please keep reading to discover if this update affects your practice.The CMS now includes several new procedure codes into its list of CLIA-waived laboratory tests.&...

Prior authorization is an eligibility verification process, which requires health care providers to obtain approval from a health insurance provider before a specific service is delivered to the patient. Providers need to improve their prior authorization strategies to reduce cases of claims denials...

Healthcare provider has never been an easy profession. Nationwide, hundreds of thousands of medical specialists risk their lives to treat patients in these extraordinary times. Many of you value your patients’ health & satisfaction over everything else. Dear doctors, you are our genuine su...

Thanks to the COVID-19 pandemic, most of us have started spending even more time looking at flat screens of our smartphones, laptops, and computers. No matter how hard it may sound to believe, vision care service providers are currently in exponentially increasing demand thanks to a pandemic that is...

Are you out-of-network with the plan but still want to accept a patient?Non-contracted practitioners can be reimbursed quite well by insurance if certain conditions apply. There are several important things to know prior to performing any service in such cases.First, it is critical to check if the p...

At WCH, we care about your practice. Our billing and credentialing experts offer an all-inclusive package of services for you to maximize your reimbursement flow. We aim to provide top-quality assistance to our clients, that is why we assign individual account representative(s) to each of you. Your ...

MUE (Medically Unlikely Edits) is the maximum number of units of service allowed, under most circumstances, for the same provider on the same date of service for the same patient.MUEs affect hospital outpatient departments, physicians and non-physician practitioners, and durable medical equipment (D...

Insurance coverage information is often confusing. Some of your patients may have coverage with up to 4 insurances or benefit plans. For example, Mary may have an active plan with both Medicare and Medicaid, Aetna, and Empire Blue Cross Blue Shield. At the same time, Mark may be an active FidelisCar...