A transformation is underway in medical coding as automation permeates medical billing. It raises many questions, such as what kind of skill sets will be needed for this new generation…
The U.S. Supreme Court ruled on a False Claims Act (FCA) case last week. As you probably know, the FCA makes it illegal for a healthcare provider to submit for…
The last several years have been tumultuous for the healthcare industry. Providers are continuing to face challenging profit margins, increased costs, staffing shortages and burnout. At the same time, consumers…
Amid the many challenges health care leaders face today, it can be easy to lose sight of some recent advances that could significantly change patient care. Here’s a look at…
Odds are, you are making these mistakes and missing out on revenue Q: What are the most common coding mistakes physicians make? A: As I work with providers across the…
The document will also be identified as CR 13136. The April 2023 Outpatient Prospective Payment System (OPPS) Update has been released and is effective April 1, 2023, and implemented on…
Several lawmakers are seeking to tie physician payment updates in Medicare to inflation to prevent potential physician shortage issues. Representatives Raul Ruiz, MD (D-CA-25), Larry Bucshon, MD (R-IN-08), Ami Bera,…
The American College of Rheumatology (ACR) commended CMS for its proposed prior authorization policies but asked the agency to expand its guidance to other utilization management tools and shorten the…
From prior authorizations to paperwork, applications are being uncovered every day. I’m about to spice things up a bit here, but stick with me. “Chuck, I’m Sydney, and I’m in…
Outpatient visits are being billed at higher levels, leading to increased healthcare spending and concerns about upcoding, a Peterson-KFF Health System Tracker found. Healthcare providers can bill outpatient evaluation and…
Following a recent US District Court ruling on the federal government’s arbitration process for disputed medical billing—making the protocol for issuing decisions on disputed claims unclear—CMS posted some clarifying guidance…
One way to assess creativity in medicine is to look at how physicians are incorporating technology such as telehealth, virtual reality (VR) and augmented intelligence (AI), often called artificial intelligence, into…
CMS proposes new rules for 2024 that apply to Medicare Advantage Plans. Last month, I told you that there would be big news coming, and sure enough, there was. The…
The anticipated issue date for the new audit is the 2024 fiscal year. Citing “consistently high error rates,” federal officials announced this week that they will be conducting a nationwide…
The final rules become effective Jan. 1, 2023. Amid this election season, the Centers for Medicare & Medicaid Services (CMS) has published final rules for the 2023 Part B Physician…
Revised ICD-10-CM codes for neurocognitive disorders are now in effect, the American Psychiatric Association (APA) has announced The coding changes for major and mild neurocognitive disorders represent "the most consequential"…