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Category Archives: Outsourcing medical billing

Reliable contract negotiation services are crucial for a thriving practice

One of the ways to increase the financial performance of a practice/ healthcare organization is payor contract negotiation. However, payor contracts can be complicated and difficult to interpret even with an attorney or consultant by the side of a physician. Hence a lot of preparation has to be done before going to the negotiating table.

A well thought out strategy needs to be planned and negotiating points to be kept in mind during discussions with payors over contract language/terms, inclusions, exclusions and coverages. Persistence in this process and successful contract negotiation pays in the long run. This is especially so in the post-COVID era with the unprecedented financial challenges faced by providers and payors. (more…)

Medical recovery services increase your bottom line significantly

Healthcare providers are committed to serving humanity, sometimes at considerable cost to themselves. They forget that the business side of their practice is also essential to keep the doors of their practice open. There are billions of dollars in disputed payments from both federal and commercial payors. (more…)

How to smoothly accomplish Medicaid provider credentialing

Medicaid is a jointly funded state and federal healthcare program that provides care to low-income individuals. Where Medicare is entirely a federal program, Medicaid, by contrast, is wholly administered by each of the fifty states within their borders.

The Centers for Medicare and Medicaid Services (CMS) provides oversight while states administer the Medicaid program. CMS issues federal regulations and sub-regulatory guidelines that states must adhere to in implementing their Medicare program.

The CMS has promulgated requirements for Medicaid Provider enrollment. Credentialing standards are set by the National Committee on Quality Assurance (NCQA) and CMS. States may also have additional regulations for providers to participate in their Medicaid program.¬† (more…)