One of the single most essential factors to maximize medical out-of-network claim reimbursement is accurate medical billing and coding. Even the slightest mistake can result in a delay or denial of a claim as payor automated processing systems are set up to deny claims for billing and coding errors. A successful coding and billing process should yield a nearly 100% claim acceptance rate. Practices also need to understand how a billing department/company has established its

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In late 2020, the No Surprises Act was enacted into law. The No Surprises Act changes the landscape for out-of-network medical billing as the NSA regulates virtually every patient claim that will present to your practice- including those for self pay and the uninsured. The law, together with the first two of many rules that have followed, contain over 1,000 pages of new requirements that will require an in-depth understanding by your medical biller in

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Xavier Becerra, Secretary of the U.S. Department of Health and Human Services (HHS) recently informed the House Appropriations Committee that he would be seeking feedback from stakeholders before enacting a policy to end surprise billing although he did not affirm whether he would use the formal rulemaking process. Typically, the rulemaking process sets out proposed regulations and then welcomes comments from all stakeholders. The No Surprises Act applies to ERISA self-funded and fully insured plans and prohibits

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View the Article on the American Society of Plastic Surgeons Website ARLINGTON HEIGHTS, IL – The American Society of Plastic Surgeons (ASPS) – the world's largest plastic surgery organization – leads the specialty's medical professionals in navigating their practices' recovery plans. As plastic surgeons prepare to resume elective procedures, ASPS is providing its nearly 8,000 members essential tools and resources, including a comprehensive playbook with enhanced patient and staff safety protocols. The Society has also organized access to

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The National Law Review posted a comprehensive rundown of what to expect on May 26th, 2020 when elective procedures resume in New Jersey with COVID-19 safety precautions in place. View the Article Here Resumption of In-Office Elective Surgery and Invasive Procedures in New Jersey Wednesday, May 20, 2020 On Friday, May 15, 2020, Gov. Murphy issued Executive Order 145, allowing physicians and dentists to resume elective surgeries and invasive procedures as of Tuesday, May 26.

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NEW YORK (Reuters) - Park Avenue plastic surgeon Dr. Douglas Senderoff usually performs tummy tucks and liposuction for well-heeled New Yorkers. But with his practice suspended because of the coronavirus crisis, Senderoff wants to help colleagues on the front lines of fighting the virus in the city’s hospitals, where healthcare workers are trying to keep up with a flood of new patients. He also has an office anesthesia machine that can be converted into a

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As our business continues to grow and we expand our services into new markets around the country, we will increasingly use this space to keep you informed and connected on industry news, big wins we have secured for our clients, and new caselaw and decisions in the Out-of-Network reimbursement market. Here you will find easy-to-read explanations of what’s going on around the country, as well as tips and tricks that you can use to help

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  By definition, a “level playing field” is a concept about fairness where all players play by the same set of rules. The underlying assumption is transparency and consistency of the rules, their definition, and their interpretation.  In other words, a playbook that all players have access to and understand. Unfortunately, in today’s reimbursement world for out of network providers (OON), the field is sorely off balance leading to potentially hundreds of thousands of dollars

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