Initially, the False Claims Act in healthcare was enacted during the Civil wall to impose liability on individuals and organizations defrauding the government. This is why FCA is also known as Lincoln Law. Since then, the False Claims Act has covered healthcare fraud and massively impacted medical billing and coding processes. Fraudulent billing practices lead to compliance issues, legal penalties, and...

On average, a doctor works around 51.4 hours a week, seeing around 11-20 patients a day. With these numbers, it’s challenging for hospitals to efficiently keep track of patient information without proper staff or encounter forms. Comprehensive and organized medical records are the cornerstone of effective management of a healthcare facility and delivering high-quality care. Encounter forms have become more crucial...

Freestanding ER may be a new trend in the healthcare industry, but they have been around for ages. The purpose of freestanding emergency departments is to provide emergency care beyond the four walls of a healthcare facility.  Emergency room billing is a major contribution to a hospital’s total workload, and managing patient care and physician billing duties can be hectic...

According to a recent survey, 26% of physicians state that patients can be potentially protected against malpractice and other medical errors with the help of physician credentialing.  Medical or provider credentialing extends beyond the assessment of a provider’s academic achievements, it encompasses a comprehensive evaluation of their experience, clinical skills, and ethical standing. Credentialing in medical billing is a challenging...

Underbilling is a serious issue in the healthcare industry, and one primary cause is the providers’ lack of knowledge regarding Medicare rules. One commonly understudied Medicare rule is the 8 minute rule. At first glance, the Medicare 8 minute rule seems fairly straightforward; treatments are billed to Medicare in units, and treatment must last no less than 8 minutes for...

People belonging to the healthcare industry, whether therapists, direct care practitioners, specialists, or chiropractors, all know that the realm of medical practice is extremely fast-paced.  Managing all operations from the front desk to the back office can be considerably challenging for healthcare organizations. But this is where a Medical Practice Management Software, also known as PMS, comes in. The benefits...

The Medicare physician fee schedule dictates how services rendered by healthcare providers are compensated under the Medicare program for their services.  Centers for Medicare and Medicaid regularly update the physician fee schedule to align with technological changes and concurrent transformations within the healthcare industry.  Some exciting transformations are awaiting the healthcare landscape in the upcoming year and at the forefront...

When a patient enters a healthcare facility to acquire treatment, one of the first things the staff does is collect the patient’s information. That information is called patient demographics. Sounds straightforward enough, right? Only patient demographics have much more depth to it than just supporting physicians in providing high-quality care.  Patient demographics serve a multifaceted role, addressing several concerns, one...

COVID-19 has brought multiple changes into our daily lives; one of those changes is a growing number of people opting for telehealth. Compared to 2019, when only 10% of people actively acquired telehealth services, a recent survey shows that approximately 52% of adults use telemedicine. Post-pandemic, there was a surge in demand for telehealth services because many patients deem it a more...

Effective management of healthcare information is incomplete without medical coding. Coding audits are a critical practice performed by a clinical coding auditor to ensure the practice has proper procedures set in place to achieve medical coding compliance.  Centers for Medicare and Medicaid Services (CMS)and the Office of the Inspector General (OIG) recommend healthcare organizations obtain an unbiased evaluation of their coding...