The Centers for Medicare and Medicaid Services recently announced major price reductions for 15 widely prescribed medications, including popular drugs like Ozempic and Wegovy. These negotiated prices will take effect in 2027 and represent significant savings for both the Medicare program and the millions of patients who rely on these medications. For healthcare providers and […]
Calquence, CMS, Ibrance, Janumet, Medicare, Medicare Part D, Negotiated Prices, Ofev, Ozempic, Pomalyst, Rybelsus, Tradjenta, Wegovy, Xtandi
The moment healthcare providers have been waiting for has arrived. After years of anticipation, CMS has officially launched PECOS 2.0, bringing a completely redesigned approach to Medicare enrollment and revalidation. This isn’t just a minor update to the old system, it’s a ground-up transformation that affects every aspect of how providers join and maintain their […]
Centers for Medicare & Medicaid Services, CMS, Medicare, Medicare Billing, Medicare Credentialing, Medicare Enrollment, Medicare In-Network, Medicare PECOS, Medicare Reimbursement, PECOS, PECOS 2.0
Healthcare providers have been sounding the alarm for years, but the federal government shutdown that stretched through October and into early November 2025 made it impossible to ignore. Critical telehealth programs and hospital-at-home waivers remain tied to short-term spending legislation, turning them into hostages every time Congress fights over the budget. When the shutdown finally […]
Congress, Congressional Approval, Medicare, Medicare Telehealth Waivers, Politics, Telehealth, Telehealth Billing, Telehealth Credentialing, Telemedicine, Telemedicine Billing, Telemedicine Credentialing, Teleneurology
For healthcare providers looking to expand their patient base and establish a stable revenue stream, becoming an in-network Medicare provider represents a significant opportunity. With over 66 million Americans enrolled in Medicare, this federal health insurance program serves as a cornerstone of healthcare coverage in the United States. However, the process of joining Medicare’s network […]
Eligibility, Eligibility Verification, Enrollment, In-Network, In-Network Credentialing, In-Network with Medicare, Medicare, Medicare 101, Medicare Advantage, Medicare Coverage, Medicare In-Network
Medical Provider Credentialing Resources Provider Credentialing and Data Management Maintaining accurate provider information across multiple platforms is essential for seamless healthcare operations. The CAQH ProView serves as a central repository where healthcare providers can input and maintain their professional data once, which then feeds into multiple health plan databases automatically. This streamlined approach reduces administrative […]
Billing Accuracy, CAQH, Clinical Documentation, Coalition for Affordable Quality Healthcare, Credentialing, Healthcare Provider Resources, ICD-10, ICD-10 lookup, Medical Billing, Medical Coding, Medical Credentialing, Medical Provider Resources, Medicare, NPI, Provider Resources
Navigating the medical billing and coding landscape demands meticulous attention to detail, as precision and accuracy play pivotal roles in securing appropriate reimbursement and upholding regulatory compliance. Among the various tools at a coder’s disposal, modifiers play a crucial role in accurately describing the circumstances under which services are provided. Medicare Modifier XU, in particular, […]
Biling Codes, CMS, Coding, Coding and Billing, Coding Intricacies, Medicare, Medicare Modifier XU, Medicare Modifiers, Modifier Xu, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Precision and accuracy are paramount in the world of medical billing and coding. Modifiers play a crucial role in this landscape, allowing healthcare providers to add nuance and specificity to their claims. Among these, Medicare Modifier XP holds a unique position, particularly when it comes to reporting services performed by different practitioners. We’ve furnished a […]
Billing Codes, CMS, Coding, Coding and Billing, Coding Intricacies, Medicare, Medicare Modifier XP, Medicare Modifiers, Modifier XP, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
Precision is key to ensuring proper reimbursement and maintaining compliance. Among the various tools at a coder’s disposal, modifiers play a crucial role in accurately describing the circumstances under which services are provided. Medicare Modifier XS, in particular, holds significant importance when it comes to reporting procedures or services performed on different anatomic sites or […]
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Accurate use of modifiers is crucial for proper reimbursement and compliance in the medical coding and billing industry. Among these, Medicare Modifier XE holds a significant place, particularly when it comes to reporting distinct and separate encounters on the same day. We provide a comprehensive understanding of Modifier XE, its appropriate use, and its impact […]
Billing Codes, CMS, Coding, Coding and Billing, Coding Intricacies, Medicare, Medicare Modifier XE, Medicare Modifiers, X{EPSU}, X{EPSU} Modifiers, XE, XP, XS, XU
If you’re a healthcare provider or facility dealing with Medicare, one thing is certain, getting properly reimbursed is a maze filled with complex rules, convoluted paperwork, and often, sheer frustration. Medicare reimbursement is the lifeblood that keeps many healthcare operations afloat, but navigating its serpentine pathways can feel like a daily battle. Buckle up as […]
APC, APCs, CMS, Geographical Practice Cost Index, Healthcare, Healthcare Billing, Inpatient Prospective Payment System, IPPS, Medical, Medical Billing, Medicare, Medicare Billing, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare Physician Fee Schedule, Medicare Reimbursement, Medicare Severity Diagnosis Related Groups, MIPS, MS-DRG, OPPS, Prospective Payment Systems, Revenue Cycle, Revenue Cycle Management
With nearly 30 million residents, Texas maintains the second largest state population in the country. This burgeoning community includes diverse urban metropolises like Dallas, Houston, San Antonio and Austin as well as remote rural towns and border communities. The variability in patient demographics and healthcare access models across Texas locations generates pronounced impacts on medical […]
Austin Medical Billing, Dallas Medical Billing, Healthcare, Healthcare Billing, Houston Medical Billing, Medical, Medical Billing, Medical Billing Service, Outsourced Billing, Outsourced Medical Billing, Revenue Cycle, Revenue Cycle Management, Revenue Cycle Optimization, San Antonio Medical Billing, Texas Care Delivery, Texas Medical Billing
As US healthcare costs continue rising steeply – now over $4 trillion representing nearly 20% of GDP – both federal and state policymakers urgently seek ways to contain runaway expenditure growth. This drive manifests through expansion of programs like Medicare Advantage and Medicaid managed care coupled with accelerating passage of game-changing legislation like No Surprises […]
Billing, Billing Best Practice, Billing Disruption, Billing Revenue, Claim Data, Consumer-Centered Billing, Good Faith Estimates, Health Level 7, Healthcare, HL7, Interoperability, Medicaid, Medical Billing Regulations, Medicare, No Surprises Act, Pre-Authorization
At Medwave, we are dedicated to providing valuable insights and guidance on detecting and preventing healthcare fraud and abuse. We will equip you with the knowledge and tools necessary to safeguard your organization and patients from these malicious activities. Implementing the strategies outlined below allows you to enhance the integrity of your healthcare services and […]
Detecting Healthcare Fraud, Fraud, Healthcare, Healthcare Abuse, Healthcare Fraud, Healthcare Fraud Abuse, Medicaid, Medicaid Fraud, Medical, Medical Fraud, Medicare, Medicare Fraud, Phantom billing, Preventing Healthcare Fraud, Unbundling, Unusual Billing Patterns
Medicare and Medicaid Fraud is a Massive Healthcare Industry Problem Medicare and Medicaid Fraud Vulnerability The Medicare and Medicaid programs provide crucial support to millions of Americans, offering access to healthcare services for those who may not otherwise be able to afford it. Unfortunately, these programs are also vulnerable to fraud, with criminals exploiting the […]
Billing for Services Not Rendered, Billing Fraud, False certification, Fraud, Kickbacks, Medicaid, Medicaid Fraud, Medical Billing Fraud, Medicare, Medicare Fraud, Phantom billing, Prescription Drug Fraud, Supply fraud, Unlawful self-referral, Upcoding, Whistleblower, Whistleblower Protection Act
What’s the Difference Between a Skilled Nursing Facility and a Nursing Home? On the surface, a skilled nursing facility and a nursing home may appear rather the same. In fact, some care facilities actually function as both, with a distinct floor or section of a building dedicated to each. The difference between a skilled nursing […]
Billing, Medical Billing, Medical Billing Service, Nursing Billing, Nursing Facility Billing, Nursing Home, Old Folks Home, Skilled Nursing, Skilled Nursing Billing, Skilled Nursing Facility, Skilled Nursing Facility Billing
Let’s begin with this set-up: Let’s say you’re hunting for a new job and receive a call from a would-be employer informing you that the job is yours. Of course, you’re thrilled by the news and inquire about your starting salary. Your new employer replies that you need to wait for your first paycheck to […]
Credentialing, Healthcare Credentialing, Medicaid, Medicare, Private Insurers, Provider Credentialing, Provider Networks, Reimbursement Rates
Home Health Services + Medicare What does Medicare Cover for Home Healthcare? If you’re looking for an answer to the question, “What does Medicare cover for home healthcare?”, you’ve probably typed it into a search engine and immediately closed the tab. The amount of information and the level of detail can quickly become confusing and […]
Healthcare, Healthcare Services, Home Health Care, Home Health Services, Home Healthcare, Medicaid, Medicaid Billing, Medicaid Coverage, Medicare, Medicare Billing, Medicare CoverageMedicare, Medicaid Fraud Examples and Steps to Ensure You Don’t Commit It *These are examples of fraud as it relates to Medicare and Medicaid. Medical fraud is the intentional deception or misrepresentation of healthcare transactions by the provider for the sake of receiving unauthorized benefits or financial gain. Healthcare fraud is committed when a dishonest […]
Billing Fraud, False Claims Act, Fraud, Medicaid, Medicaid Billing, Medicaid Fraud, Medicaid Fraud Examples, Medical Billing Fraud, Medicare, Medicare Billing, Medicare Fraud, Medicare Fraud Examples, Upcoding
The Reasons Why a Medical Billing Assessment is Needed Medical Billing Assessments Running a healthcare practice means keeping a tight ship for the sake of your patients and your reputation, as well as your financial well-being. But, let’s face it, practices are only as successful as their medical billing performance. If you have a prosperous […]
Healthcare Billing, Medical Billing, Medical Billing Assessment, Medical Billing Company, Medical Billing Cycle, Medical Billing Profit, Medical Billing Service, Medical Billing Strategy, Outsourced Medical Billing
Understanding Medical Billing Myths Dr. John Smith owns a small practice in Pittsburgh’s South Hills. He’s in the midst of a conversation with one of his nurses. Nurse: “Doctor, do you think we should be posting signs concerning the payment of co-pays once the patient is finished with their appointment?” Doctor: “I agree to a […]
Healthcare Billing, Healthcare Providers, Medical Billing, Medical Billing Myths, Medical Billing Service, Outsource Billing, Outsource Medical billing, Outsourced Billing, Pittsburgh Medical Billing
“This procedure will require prior authorization.” Words that no patient or healthcare provider wants to hear when they are ready to proceed with a doctor-approved procedure for a medical matter. However, it’s one of the utilization management tools that insurance companies have fostered to decide if specific prescribed procedures, services and medications are medically required […]
Health Insurance, Healthcare, Healthcare Providers, Medical Billing, Medical Credentialing, Medical Practice, Medicare, Prior Authorization, Prior Authorization Process, Revenue, Revenue Cycle, Revenue Cycle Management, Utilization Management
Billing & Payment Processing for Medical Marijuana Cannabis A Proven Commodity Marijuana Cannabis is projected to be one of the fastest-growing industries over the next decade. Worldwide cannabis sales more than tripled, from $3.4 billion to $10.9 billion between 2014 and 2018, and Wall Street has forecast that sales will grow $30 billion by 2025. […]
Cannabis Billing, Cannabis-Friendly Payment Processors, Cannabiz, Marijuana Billing, Marijuana Payment Processing, Mary Jane Billing, Medical Billing, Medical Cannabis, Medical Cannabis Billing, Medical Marijuana, Medical Marijuana Billing, Outsource Medical billing
Truth is, many patients know little more about their physician’s qualifications than what they see neatly hanging from their office wall. While they’re able to access in-depth background information about their auto mechanic, it’s when they are at their most vulnerable, entrusting their family’s health to a qualified healthcare professional, is when they must hope […]
Credentialing, Credentialing Value, Healthcare Credentialing, In-Network, Insurance Companies, Medical Credentialing, Medical Provider Credentialing, Payor Contracting, Payor Enrollment, Provider Credentialing
Medical Billing Techniques that Can Be Installed to Help Your Medical Practice Health care providers should periodically review their financials and revenue cycle, so that they can take corrective measures at the earliest if required. A great deal of medical offices / health care providers find that medical billing is one area which could be […]
AI, Automation, EHR, Medicaid, Medical Billing, Medicare, MIPS, Outsource Medical billing, Pittsburgh Medical Billing
MACRA is Coming in 2019 How you and your practice get paid is soon going to change. The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, is remodeling the way providers are reimbursed for Medicare services. While this may not affect everyone who bills for Medicare services, it will greatly impact smaller offices […]
Advanced Alternative Payment Model, APM, cms.gov, Cranberry Medical Billing, EHR, Electronic Health Record, MACRA, Physician Quality Reporting System, Pittsburgh Billing, Pittsburgh Medical Billing, PQRS, Value Based System, VBM