Enforcement & Compliance Although there is some enforcement discretion as the regulatory authorities work out the details, it is necessary for providers to be compliant in the areas that are clear and established. Although the original objective was to protect the insured patient, it also protects the uninsured, self-pay patient. As already stated, the law…

What is the No Surprises Act? The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020. The Act contains many provisions that protect patients (consumers) from surprise bills. The No Surprises Act protects people covered under group and individual health plans from receiving unexpected bills when they seek emergency care, out of network…

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Download Reference Documents When verifying benefits, it can be a challenge identifying which is primary, especially when the patient hands you a couple of cards and ask you to figure it out. The patient guide titled Your Guide to Who Pays First is a great resource for providers. Since the document is created with the…

Medicare Verification FAQs Q: I called to verify Medicare for a patient and was asked for a PTAN number. What is it & why don’t I have one? A: Medicare Providers are issued Provider Transaction Access Numbers (PTANs) for each place they work. The PTAN identifies the person that renders services to Medicare Beneficiaries in…

Due to the many options and layers of Medicare coverage, verification is a necessity. Most beneficiaries are unaware as to what type of coverage they have. They rely on clinic staff to help them make heads or tails out of their benefits and coverage. A great way to show your respect for the older generation…