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What is a Superbill? What information does it contain?

A medical superbill or encounter form is the primary source of data for preparing claims and contains the list of services provided to a patient. Along with the list of services, the superbill will show the costs and codes for each exam, treatment, or procedure. It will also contain information about the patient, provider, CPT codes, ICD-10 codes. These details have to be accurate so that claims can be prepared correctly.

A superbill is not necessarily needed for preparing claims by the provider. However, a patient would require a superbill in case (i) the provider is not part of their insurance company‚Äôs provider panel, (ii) they are having a Health Savings Account (iii) they are utilizing out of network benefits and need to meet a deductible(s). In these cases, the superbill helps the patient to work directly with their insurance plans. (more…)

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DENIAL MANAGEMENT: 5 EFFECTIVE APPROACHES TO SHRINK DENIALS

Claim denials may be nothing unusual in healthcare, but the amount denied actually adds up to a substantial sum in the long run and is a loss of revenue for the practice. Studies have shown that many practices do not appeal to denial as they consider the denial management process expensive compared to the amount they will receive from payors.

This erroneous thinking results in leaving money on the table as statistics show that I in 5 claims is denied. Denial management is, therefore, something that every practice should take seriously.

The quantum of claim denials in a facility can be brought down by following the 5 approaches listed below: (more…)

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WHAT IS HIPAA COMPLIANCE? WHO MUST BE HIPAA COMPLIANT?

The Health Insurance Portability and Accountability Act of 1996, known as HIPAA, is a series of rules and regulations that govern the use and disclosure of protected health information (PHI). HIPAA compliance is monitored by the Department of Health and Human Services (HHS) and enforced by the Office for Civil Rights (OCR).

It is essential that a HIPAA Covered Entity or a Business Associate with access to Protected Health Information understands the rules and how to become HIPAA compliant. Ignorance of rules is no defense against enforcement action.

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