Medical Billing and Coding Services | MIPS Reporting and Consultation Services

What is Medical Billing Fraud? Medical billing fraud occurs when a healthcare provider or billing company submits false or misleading claims to insurance companies or government programs, such as Medicare or Medicaid. These fraudulent claims may include services that were not provided, services that were unnecessary, or services that were overbilled. Medical billing fraud can also involve kickbacks, where providers receive payment for referring patients to certain healthcare services or products. Medical billing fraud can result in significant financial loss for patients and healthcare providers. Patients may be charged for services they did not receive, while providers may face legal and financial consequences for submitting false claims. Tips for Detecting Medical Billing Fraud ·      Detecting medical billing fraud can be challenging, as the fraudsters often use complex billing codes and procedures to conceal their activities. However, there are several si...

Reasons to Outsource Medical Billing Management  Well, in 2019 according to a report by the American Hospitals Association, uncompensated hospital care costs exceeded $620 billion. Just because of the failures in claim processing, billing payment, and bad debt collection cost healthcare providers over $300 billion annually. As per Mckinsey’s article, around 99% of medical bills over $3000 were not paid. Well, according to Bloomberg, bankruptcies in the healthcare industry tripped in 2017. In the first six months of 2018 over eight hospitals were declared bankrupt and the other nine closed their doors. These statics has highlighted the major healthcare issues faced by US healthcare providers these days such as revenue erosion. There are so many factors that are responsible for this problem. The complexity of regulations, demolish nature of the US healthcare system, and billing inefficiencies are the major ones.  Let’s discuss the reason to outsource medical billing manageme...

The new rule addresses nearly all concerns related to surprise medical bills. It gives a guideline about areas where clinicians have to be careful and how state and federal rules can work together. CMS has promised the betterment of the healthcare system in the US through its Merit-based Incentive Program. That’s why it has made several changes every year. Currently, MIPS 2022 is almost at its ending phase and we have MIPS 2023 framework. Thereby, clinicians are now in a hurry to fulfill the current data completeness requirements for the upcoming MIPS reporting program. MIPS 2023 will have a relatively rigid framework. Those clinicians who are deciding to report quality measures in MIPS 2023 are entered in the preparatory phase. MIPS reporting for quality measures requires clinicians to submit data for 70% of eligible encounters to CMS. However, this weightage will be upgraded for MIPS 2024 and 2025 PY. Read more: https://www.p3care.com/news/hhs-introduces-surprise-bill-compliance-ru...