Most insurance carriers require a W-9 form from both in- and out-of-network healthcare practitioners. But have you ever wondered why it is so integral, not only for reimbursement, but also for credentialing? A W-9 is a standardized legal document that payers use to collect your EIN or tax ID numbers. Now, here’s a fun fact: […]
Spine-related surgical procedures are usually complex to bill. This is because accuracy depends on understanding not just the codes, but also the surgical approach, the spinal region involved, and the number of interspaces or vertebral segments treated. However, the complexity does not ruleout the necessity of accurate coding for spine surgery. Medical billers must stay
The CPT code 55250 represents a vasectomy, which can be unilateral or bilateral, depending on the situation. Vasectomy is an invasive procedure that involves cutting and sealing the vas deferens. This is generally referred to as sterilization. But how do the CPT code guidelines apply to this? Is such a procedure common, and what are
Let us begin by asking you some simple questions. Why should insurance payers trust you with their money? Why should they refer you to their policyholders? And most importantly, why should patients come to you instead of going to any other healthcare provider? CREDENTIALS! It is all about the credentials! Only verified, trusted, and credentialed
Did you know that in the United States, on average, 1.5 million patients are transferred between acute care hospitals annually? These transfers can be for several reasons. One of the most common reasons is to receive necessary treatments and services only available at other centers. Have you ever encountered a ‘transfer of care’ case where
Did you know that, as of 2024, 317,545 laboratories are currently registered with CLIA, including both exempt and non-exempt facilities? The Clinical Laboratory Improvement Amendments (CLIA) of 1988 comprise a set of regulations that apply to all U.S. facilities that test human specimens for health or disease assessment. The Centers for Medicare and Medicaid (CMS),
There are 6,100 hospitals in the United States. The largest among them is New York-Presbyterian Weill Cornell Medical Center, with a bed count of 2,850. Wondering how many patients visit this hospital per year? Nearly 3.31 million according to official figures. On average, that’s over 9,000 patient visits per day! With such a high influx
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Did you know 82% physicians in the United States agree that pre-authorization requirements sometimes force patients to abandon care? This might bring you to the million-dollar question: In an emergency, should the provider wait for payer approval or do what they pledged, i.e., save lives? Definitely, patient care should be prioritized! There is a process
This guide covers everything you need to know about the Tricare credentialing process, from the steps involved to key requirements, challenges, and best practices. However, before we discuss the details, let’s quickly review Tricare insurance! TRICARE is the Department of Defense’s (DoD) worldwide healthcare program available to eligible beneficiaries of the eight uniformed services. These
Did you know that the Recovery Audit Contractor (RAC) audit program was introduced as a pilot project in only three states in 2005? These states were New York, Florida, and California. It was initiated to find and correct improper payments made in the Medicare program. Between 2005 and 2008, $693.6 million was returned to Medicare
What is a Recovery Audit Contractor (RAC) Audit? Read More »
