Practical Billing Solutions, Inc.

03/19/2019

03/08/2019

You’re probably aware that CMS runs your Medicare claims through an automated system of algorithms to identify errors and improper billing practices. But did you know that its upping its auditing activities in 2019 — and the focus is on physician practices? Could you be next in line?

Make certain to review your notes and return additional information requests quickly.

Contact PBSI for complete billing services.

07/18/2018

With CMS resuming medical necessity audits through QIOs and RACs and commercial payers continuing to issue denials, downgrades, and pended decisions, medical practices are struggling to counter the toll on their financial health. Many organizations face a daunting backlog of denials, some of which represent hundreds of thousands of dollars at risk.

Recovering your lost revenue from denials can help you preserve profitability in the face of limited operating margin. Yet, managing appeals is time consuming. Tracking claim judgements, researching reasons for denials, collecting necessary documentation, and writing and submitting appeals is labor-intensive, especially when your staff is under-trained.

Let PBSI help.

07/11/2018

According to the Centers for Medicare and Medicaid Services (CMS) guidelines, providers must maintain clear and concise medical record documentation.

Many of us already know this familiar phrase, “If it has not been noted in the record, then it never happened.” A procedure must be indicated and substantiated on the chart and included in the Electronic Medical Record (EMR) for the payers (and auditors) to accept a claim for that service. Poor record-keeping can mean the difference between a lawsuit that is indefensible and one that can be substantiated in court. Documentation is the physician’s best weapon in his arsenal to maximize both patient care and payer reimbursement.

Triumph over the biggest challenges for clinical documentation improvement (CDI) in ICD-10 and get the inside scoop on CDI for EMRs, E/M, hospice, home health, and more—with the services of PBSI.

02/07/2018

When Medicare patients present with trauma related to workmen’s compensation or other third párty circumstances, it is crucial that these situations are identified at the time of registration. You must take certain steps at strategic times to protéct your revenue. Errors made in patient accéss often create a ripple effect throughout the process, resulting in the inability to secure timely payment. Don’t compromise your ability to collect these claims. Learn what steps are required and when action must be taken to support your request for a conditional payment.

Liabílity policies have limits to the medical coverage. Misunderstanding the steps and necessary actions will likely cost you. Timeliness and proactive measures are the keys to staying in the gamé. Medicare will be secondary to the liabílity coverage. Does your staff know how to actively pursue the correct pathways to obtain payment?

Ask the facilities that you work in to always fax or email a secure copy of insurance changes or responsibility to your billing facility daily.

02/07/2018

Is rework a problem for your coding and billing team? If your practice is like most, you’re constantly striving to fend off denials and climb out of the appeals abyss.

Tracking claim judgements, researching reasons for denials, collecting necessary documentation, and writing and submitting appeals is a giant headache! But denial management processes needn’t be so laborious, time-consuming, and confusing. The team at PBSI acts as an extension of your practice and handles these issues for you. PBSI offers referral fees to anyone who refers a physician who signs a billing agreement.

02/06/2018

Did you know that services—and the reasons for providing them—are the core of establishing medical necessity. While coders are responsible for reporting procedures with the correct codes, they must coordinate with billers and physicians to ensure documentation includes the proper diagnoses to meet payers’ medical necessity requirements. Reporting a code for a procedure that is not deemed medically necessary by payers, including CMS and third-party companies, means that code will not be paid—even if the physician believes the procedure was necessary.

To worsen matters, it’s not just claim denials at stake anymore. Get medical necessity wrong and it’s considered by CMS as a “knowingly false” act—with civil penalties of up to $11,000 per false claim

Let us help you establish medical necessity, simplify bundling decisions, and bill confidently for your patients daily.

01/30/2018

Just a reminder, the Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are updated in January of every year. Please verify you are using the most current codes for your services January 1, 2018, and after. Numerous claims are denied or paid incorrectly when not using the most current codes. The most common cause of billing and payment errors are with drug codes where the dosage or route of administration may have changed, new codes, changes in descriptions of the current codes, and codes for new services.

PBSI updates fees and procedures as new information is issued by CMS and other entities.

01/11/2018

Our expert team has more than 25 years of experience! We strive to provide the most accurate billing and payment entry services. Visit http://www.pbsiusa.net/about-us-Medical-Billing-Software--Physician-Billing--Medic.html to learn more.

01/08/2018

According to the Centers for Medicare and Medicaid Services (CMS) guidelines, providers must maintain clear and concise medical record documentation.

Many of us already know this familiar phrase, “If it has not been noted in the record, then it never happened.” A procedure must be indicated and substantiated on the chart and included in the Electronic Medical Record (EMR) for the payers (and auditors) to accept a claim for that service. Poor record-keeping can mean the difference between a lawsuit that is indefensible and one that can be substantiated in court. Documentation is the physician’s best weapon in his arsenal to maximize both patient care and payer reimbursement.