Theodore Roosevelt once said: “Nothing in the world is worth having or worth doing unless it means effort, pain [and] difficulty.” While the former president’s outlook is a bit extreme,…
The costs to medical practices for implementing the International Classification of Diseases-10th Revision (ICD-10) coding system have been grossly underestimated, according to a recent study by Nachimson Advisors for the…
From patient accounting systems to sticky notes and "cheat sheets" posted in exam rooms, ICD-9 codes permeate the health care environment, translating the information in medical records to numbers on…
Mark your calendars -- the Centers for Medicare and Medicaid Services (CMS) announced it will conduct front-end testing of ICD-10 billing code submission between Medicare Administrative Contractors (MACs) and providers.…
Risk Managers and workers’ compensation claim managers normally know the purpose of medical bill review is to reduce medical bills to the state fee schedule or to the previously agreed…
Gov. Pat McCrory signed legislation into law Wednesday that he said will help North Carolina consumers make better health care decisions and aid his administration in running state government more…
Medical bill errors can quickly become a nightmare for both caregivers and their loved ones. The longer an error goes uncorrected, the less likely it is that you will be…
Healthcare providers may face disruptions in their payments even if they are on target to operate using ICD-10 codes on Oct. 1, 2014. Since providers will, and indeed need, to…
There was a time not that long ago that a patient might never see a medical bill, much less have to read it. But few of us can afford to…
Outsourcing medical coding and billing requirements is definitely beneficial in terms of reduced workload, better performance and improved revenue. However, the task of hiring a medical coding company should be…
If you've ever had to deal with large medical bills, you probably know the pain of trying to make sense of all the charges. Orem resident Ruth Cuell received a…
When most go to the doctor their main concerns are diagnosing their health issue and getting better. Then at some point, the medical bill may become a concern. Will their…
The health care industry is “not progressing at a suitable pace” to be ready for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures…
Medical billing outsourcing enables maximum reimbursements for all submitted claims, because the billing is done in a very efficient manner. Efficiency can be ensured only by a reliable and reputable…
Here are the pros and cons to help guide your decision.
Question: Our practice is considering accepting patients with PFFS plans. We’re heard that some patients are starting to have them, but we’re not sure whether we’re going to accept them or not. Are PFFS plans beneficial for us?
Answer: PFFS are Private Fee-for-Service plans, which are non-network plans. These plans let members receive care from any doctor or hospital that accepts the plan’s payment terms and conditions.
If your practice decides to accept these terms, you would become a “deemed” provider. Plan members can receive covered services from any deemed provider in the U.S. However, member patients must confirm that the provider is deemed every time a service is provided.
PFFS plans are different from Medicare Advantage plans because they do not require a doctor or hospital to contract with a health plan to provide services. This means that doctors or hospitals that do not agree to the PFFS plans’ terms and conditions may choose not to provide health care services to a plan member, except in emergencies.
Coming soon: Starting in 2011, PFFS plans will have to measure and report on their providers’ quality of care. But the catch is that they’ll also have to form provider networks with contracts.
In counties where there are two or more non-PFFS plans, PFFS plans will no longer be able to simply “deem” providers into the plan without a contract. Under current law, PFFS plans don’t have to prove they can meet access standards if they allow any willing qualified Medicare provider to participate, and they pay as traditional Medicare would pay.
One argument is that the network requirement would provide better access to care because there would be contracts between the providers of services and the plan. On the...
Save this option for when other collection methods have failed.
You’ve offered discounts, payment plans, and more,but you still haven’t received payment from a patient. You may be forced to do a write-off at this point, says Steve Verno, CMMC,...