Contents tagged with billing
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Doctors report insurers are auditing billing procedures for services provided by NPs, PAs
Physicians should examine insurer contracts, provider policy and procedure manuals to ensure compliance
If you employ nurse practitioners or physician assistants, you should make sure you’re complying with each payer’s protocols when billing for services provided by nonphysicians. TAFP has recently heard from members who thought they were billing properly but have found themselves under investigation by payers. If these practices are found to be out of compliance, they may owe payers substantial refunds.
Many payers pay reduced fees for services provided by NPs and PAs but the rules and billing procedures doctors should follow when filing claims differ from payer to payer. For instance, Blue Cross Blue Shield of Texas pays 15 percent less for services provided by NPs or PAs than they would for services provided by the supervising physician. The insurer requires that practices include a “Modifier SA” when filing claims to indicate that a service was performed by an NP or a PA.
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TAFP members: I’m here to help
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TAFP members: I’m here to help
By Bradley Reiner
Did you know?
Did you know the Texas Academy of Family Physicians has a practice management consultant representing you?
Did you … more
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Get answers to your practice management questions through new TAFP partnership
Get answers to your practice management questions through new TAFP partnership
posted 02.12.08
TAFP has partnered with a practice management consultant, Bradley Reiner, to provide staff and … more
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HIPAA COMPLIANCE: Does your family practice know who your business associates are?
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By Julie Sheppard, B.S.N., J.D., C.H.C.
Most physician practices, including family practices, are already aware that the HIPAA Omnibus Rule (enforcement date was Sept. 23, 2013) … more
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A better way to value family physicians’ work
By Richard Young, M.D.
Ms. M was a 68-year-old Hispanic female who had not seen Dr. Smith (not his real name) in nearly a year. She had run out of her diabetes, high blood pressure, and cholesterol medications months before.
Ms. M had other concerns in addition to these three chronic diseases and the practical difficulties she faced filling her prescriptions. She asked Dr. Smith to help her with her foot pain and knee pain. She was told by another doctor at an ER that she had visited for a non-urgent problem a few months prior that her blood potassium level was low. She expected Dr. Smith to address her heartburn, recent weight gain, bad teeth, and an additional but distinctly different abdominal pain. She wanted a test for her kidney function, for which Dr. Smith had to spend a couple of minutes trying to figure out why she was concerned about her kidneys in the first place and the results of blood tests at other facilities such as her recent ER visit. Dr. Smith also spent several minutes explaining the need and importance of osteoporosis screening, which she ultimately declined.
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Practice operations
Practice operations
TAFP partners with Bradley Reiner to provide family physician members with practice management assistance.
> See more about Reiner
Billing and coding
The Oct. 1 … more
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What you don’t know can hurt you
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By Bradley Reiner
You’ve probably been reading more than you should about groups of doctors sending back money. Accusations of incorrect billings, fraudulent behavior, and false … more
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HHS proposes one-year delay of ICD-10 deadline
HHS proposes one-year delay of ICD-10 deadline
posted 04.12.12
The Department of Health and Human Services announced Monday, April 9, their intention to delay the compliance date for the … more
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Recovery audit contractors: The age of audits and remediation
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The age of audits and remediation
By Kate Alfano
It’s a fact of medical practice that despite the best intentions, a physician who does not know how to correctly code for his or … more
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Billing and Coding
Billing and coding
ICD-10 guidance from AAFP and Family Practice ManagementWith the Oct. 1 deadline looming, both AAFP and the AAFP Family Practice Management journal have compiled a set of … more