Credentialing: Why Should I Hire a Professional?

In the words of Red Adair, “If you think it’s expensive to hire a professional to do the job, wait until you hire an amateur.” Credentialing dictates how you bill. Do I bill as a group? Should I credential my nonphysician practitioners (NPP)? Which place of service (POS) should I bill with based on my contract? These are all important questions. Did you know that in April of this year, an urgent care chain reached a $22.5 million settlement with the U.S. Attorney’s office under the False Claims Act for …
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Can I Bill Patients for COVID-19 Vaccine Administration?

As practices start offering vaccinations for COVID-19 to their patients, we are getting a lot of questions about whether the patient can be billed for the administration. The answer is an emphatic No. The Office of the Inspector General has received complaints from patients about charges by providers when getting their COVID-19 vaccines. So, on April 15, 2021, the Principal Deputy Inspector General Christi A. Grimm issued a message regarding provider compliance with the COVID-19 Vaccination Program. All participating organizations and providers must administer the COVID-19 vaccine with no out-of-pocket …
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New Technical Corrections Issued by the AMA Explained

On March 9, 2021, the American Medical Association updated the new evaluation and management (E/M) coding guidelines with technical corrections. These clarifications apply to the office visit codes 99202–99215 and are retroactive to January 1, 2021. In the past few months there has been industry confusion over whether a test can be counted under the data element for the E/M level when the practice is also billing for the test. The AMA has answered this question with further guidance. Which In-House Tests Should Be Counted? The Services Reported Separately section …
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Credentialing and Contracting: What to Expect When Expanding

For those trying to grow their urgent care business, conversations around payer contracting and credentialing (CC) can often be overwhelming and seem contradictory to the mission of On-Demand Care. Tammy Mallow, our resident Experity advisor on all things CC says she often finds herself being the perceived as a “dream killer” when educating owners to the inner workings of this process. Established groups often expect the payer rules to be the same as they were years ago, only to find they may not be able to add a new location …
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Last Minute Coding Changes for 2021

December brought us some last-minute coding changes. In some cases, this caused a small claim delay as clearinghouses and payers scrambled to update their systems. New ICD-10 Codes for COVID-19 Effective January 1, 2021, there are new ICD-10 codes for reporting COVID-19 related diagnoses. These codes replace the existing codes we are using that are not as specific. There are two other new codes: 81 (Multisystem inflammatory syndrome (MIS)); and 89 (Other specified systemic involvement of connective tissue). For patients diagnosed with (MIS) and COVID-19, report U07.1 with M35.81 as …
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