Main Points Be Clear Be Concise Be Constructive The reality of high deductible health plans (HDHPs) is still setting in. Patients are choosing to pay less in monthly premiums in exchange for HDHPs, but this places more of the financial burdens on the patient when it comes to paying for health care. This strategy is called assuming downside risk. This means that they pay lower premiums but the downside is that they will pay more in health services. Due to more patients assumin

Explaining insurance benefits to a patient in your private practice is a very important process and will greatly improve your mental health

Main Points Insurance cards are critical to successfully bill insurance Insurance cards help you to manage your billing A/R Insurance cards help your biller to speed up payment There is a lot of information you will need when taking on insurance! At this point, you have applied to the insurance panel, gotten credentialed, marketed your practice, and now you have a patient that is interested in using your services! This is very exciting because you have a business that people

Main Points A claim appeal is when a therapist wants to dispute a claim decision by an insurance company based on medical necessity or errors made on the part of the insurance company Each insurance company has their own appeals process and each has very specific requirements in order to process an appeal According to CMS and the ACA, patients and providers have the right to a fast appeal. Unfortunately, this rarely happens and it can impact your practice and patient care in

Main Points Medicaid is open to a variety of citizens who fall below the poverty line Medicaid is a federal program but states can choose to provide Medicaid coverage to other groups as well The ACA established federal regulations for modernized, data driven approach to verify financial and non-financial information to determine eligibility Medicaid and Children's Health Insurance Program (CHIP) cover over 60 million Americans. The demographic that this includes span children

Main Points Coordination of benefits (COB) allows an insurance plan to know where they fall in the reimbursement chain A miscommunication in coordination of benefits can inhibit insurance companies from paying on claims The way an insurance company knows the coordination of benefits can vary, and the patient is ultimately responsible for knowing their benefits One of the most misunderstood denial reasons that providers receive is called "coordination of benefits". What does t

Main Points Why did the codes change in 2019 Definitions of the codes simplified The feedback codes vary between psychological and neuropsychological tests The change to the new testing codes in 2019 caused quite an uproar in the testing and psychological community. The last change we saw a change to the testing codes was in 2014 when 96101, 96105, 96116, 96118, and 96125 were introduced. However, after CMS evaluated the reimbursements based on these codes they found that re

Main Points Medicaid is open to a variety of citizens who fall below the poverty line Medicaid is a federal program but states can choose to provide Medicaid coverage to other groups as well The ACA established federal regulations for modernized, data driven approach to verify financial and non-financial information to determine eligibility Medicaid and Children's Health Insurance Program (CHIP) cover over 60 million Americans. The demographic that this includes span children