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Blog Posts by Author: Leigh Polk

No Surprises Act: Examining the Independent Dispute Resolution Process

The Final Rule implementing the No Surprises Act provides new guidance for the payor-provider independent dispute resolution (IDR) process. The Final Rule directs certified IDR entities to consider the qualifying payment amount as well as certain other specific factors when resolving out-of-network rate disputes and requires payors to be more transparent about changes to codes or modifiers that...

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No Surprises Act: 4 Key Steps to Providing Good Faith Estimates

The No Surprises Act protects patients from receiving a surprise medical bill by prohibiting balance billing and requiring providers to provide good faith estimates (GFE) of services. A GFE should be provided to all patients who are uninsured and should include all services expected to be provided by both primary and co-providers.While the legislation went into effect on January 1, 2021, HHS did...

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Optimizing Patient and Payor Payments with Patient Responsibility Estimator Tool

In 2021, the total US out-of-pocket healthcare patient spending increased by 10% from the previous year and is expected to continue to increase by 9.9% annually through 20231. An increase in a patient’s financial responsibility is a growing problem in healthcare and is driven by several factors including: Payors shifting a larger portion of the payment to patient responsibility, on average...

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Mitigating 2023 Proposed Medicare Reimbursement Cuts

Over the past few years, due to the public health emergency (PHE), Congress has stepped in to halt pending Medicare cuts. However, legislative intervention during the PHE only delayed the cuts until the following year. With the proposed 2023 Medicare Physician Fee Schedule released in July, which contained several reductions, and the return of the 2% sequestration, healthcare providers need to...

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How Real-Time Connectivity Can Drive Revenue, Reduce Cost, and Increase Client Satisfaction

In today’s healthcare environment, there is a lot of uncertainty about what revenue will look like in the face of declining reimbursement, increasing payor denials, and staffing shortages. At the same time, there are greater expectations on the workforce to comply with regulations and payor reimbursement requirements, which can differ by payor and state. Therefore, it is essential for healthcare...

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Three Steps to Radiology MIPS Success

There are three critical steps to maximizing Medicare reimbursement by optimizing your MIPS score. But first, radiologists need to understand the 2022 MIPS changes and requirements that must be met to avoid the negative 9% payment adjustment for noncompliance and achieve a bonus.Physicians have two tracks to choose from under the CMS Quality Payment Program: MIPS and Advanced Alternative Payment...

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Three Questions You Should Be Asking to Determine if the No Surprises Act Applies to You

How do the billing protections established under the No Surprises Act impact my group?This is what everyone is asking. It’s a very complex question that isn’t answered with a simple yes or no. However, listed below are three questions you should ask to determine if any of your services are impacted by the No Surprise Act legislation.*  Is the...

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No Surprises Act: Your Top Questions Answered - Part 2

This blog is part two of a blog series focusing on answering the most common questions regarding the No Surprises Act. View Part One, which focused on questions related to providing a good faith estimate and obtaining patient consent.The No Surprises Act (NSA) — which provides patient protections by addressing surprise billing and banning balance billing — has many people wondering which parts of...

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