Healthcare News

COVID-19 pandemic has already been with us for almost 2 years. Back in early 2020, when states and the federal government rushed to proclaim a public health emergency, many patients had been concerned about whether they would continue receiving care in a matter of a lockdown. Luckily, the CMS has qu...

Healthcare providers who currently receive relief funds from the United States Health Resources and Services Administration are required to report their Provider Relief Fund payments. Those who have failed to do during the first reporting period in 2021, are obliged to submit this information t...

Effective October 1st, 2021, New York State Medicaid requires Drug Enforcement Administration-eligible Medicaid-participating healthcare providers. Basically, any healthcare provider who can make a prescription is obligated to fill & submit this form. This regulation applies to physicians, ...

Effective February 4, 2022, UnitedHealthcare will stop mailing appeal decision letters and paper-based explanations of payment (EOP)to healthcare providers in 15 states, including New York and New Jersey. UHC is encouraging its participating physicians and groups to utilize its provider portal. The ...

Just like any other healthcare provider, dental practitioners are required to initiate the credentialing process in order to become enrolled with any insurance or a benefit plan. However, this process is a little bit tricky because dental insurance plans are almost always part of separate, dent...

Today we would like to talk about the complexity of reimbursement flow experienced by those who only render equipment to their patients. There are several myths about DME billing. Let us debunk each of them.DME services need to be billed on a distinctive claim formNo, equipment is billed on the same...

On November 12, 2021, the CMS has announced a notable and rapid increase in Medicare premiums for the calendar year 2022. This 14.5% spike in Medicare Part B premiums will enlarge monthly premium payments for those in the lowest income bracket from a current $148.50 to $170.10 in 2022. This wil...

Claim denials are always frustrating. A large portion of underpayments occurs because of improper claim processing by insurance payers. However, in some cases, denials may as a result of a provider being non-compliant with a payer’s coding policy, or even with the one established by the CMS. N...

Recently some healthcare providers have reported having a negative balance with certain several insurance carriers they are participating with. Having a negative balance leads to a significant disruption in insurance payments, but it is not the end of the world. There are several ways of "fixing...

Claim timely filing limit is a specific period during which a provider may submit an insurance claim for the rendered services to the payer. In most cases, this period is defined by the number of calendar days since the date when a procedure has been performed. Should a claim be submitted outside of...

Pursuant to regulation by the US Department of Health and Human Services (HHS) on COVID-19 testing cost-share waivers issued on March 13th, 2020, outpatient healthcare providers are required to indicate a cost-share waiver in their claims for services performed on Medicare Part B patients.Namely, th...

Starting from November 1st, 2021, NYSDOH has increased fees for PDN services for eligible beneficiaries aged 23 or older. This increase is temporary and is planned to be waived on March 31st, 2022. The following services are affected:S9123 - Nursing care, in the home by a registered nurse, per ...

Following a recent FDA approval of the Pfizer-BioNTech COVID-19 vaccine for children 5 through 11 years of age, the CMS has determined that it is now covered for eligible individuals. Namely, individuals insured under Medicare, Medicaid, the Children's Health Insurance Program, as well as under...

The NY State Workers' Compensation Board has ruled out that effective July 1st, 2022, providers would need to use the CMS-1500 claim form for medical bills submission. This decision has been made to simplify this process and relieve providers from a significant portion of the paperwork. ...

Centers for Medicare & Medicaid Services has recently released an updated version of the ICD-10-CM for the fiscal year 2022. An updated set of diagnosis codes came to an effect on October 1st, 2021.The current edition includes 159 additions, 25 deletions, as well as 27 revisions. Here ...