is this really necessary?

Is this really necessary? J. Morse 4/1/19 The hot topics in the arena of dialogue will soon turn again to health care and most certainly will include discussion on the cost of prescription drugs. We understand the fireworks. Pharmaceutical companies invest billions in research and development. Legislation to ensure safety requires lengthy, costly trials to defend the science behind the …

NPI and Billing

What is an NPI? Let’s first discover what exactly an NPI is, then explore the details.  NPI is simply an acronym that stands for National Provider Identifier number.  An NPI is a 10 digit number assigned by the Centers for Medicare and Medicaid (CMS) to health care providers, organizations and group practices.  Prior to the use of the National Provider …

Five things to know about Sequestration

Here are the five things you should know about sequestration: 1.  What is sequestration?  It is the mandatory 2% payment reduction in the Medicare fee-for-service (FFS) program required by the Budget Control Act of 2011. 2.  Who does it affect? All providers of medical services that are reimbursed under the Medicare fee-for-service (FFS) program (i.e., Part A and Part B) …

Understanding an EOB and Your Bill

An Explanation of Benefits (EOB) is the document that health insurance companies send to communicate their decisions to members regarding payment for services. Every insurance company EOB is different, and many of them are difficult to understand. An EOB is not a bill, but it usually will have enough information for the member to review what the physician will eventually …

Do You Do RVUs?

Clinical staff members have complex languages all their own: diagnoses, medications, symptoms, anatomy.  Now many physicians are becoming familiar with a more financial language, “Relative Value Units” (RVUs). As more and more physicians are practice/hospital employees, they need to be aware of all the factors that determine how they are reimbursed. Most contracts start with a base salary, a guaranteed …