ICD-11 Implementation Prompts Request for Information

A Request for Information has been published in the Federal Register (Federal Register :: National Committee on Vital and Health Statistics; Meeting and Request for Information) asking comments on ICD-11…

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OIG: Medicare Overpayments Due to Coding Discrepancies Totaled $22.5M

Medicare improperly paid practitioners at a higher non-facility rate for services provided to skilled nursing facility (SNF) or hospital inpatients, leading to over $22 million in over-payments, a report from…

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Supreme Court Issues Landmark FCA Ruling

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…

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New Changes from CMS for HCCs Reimbursement

Hierarchical Condition Categories (HCCs) and value-based care have been a major focus for healthcare organizations during recent years. As many of you may know, the Centers for Medicare & Medicaid…

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Moving The Needle In Healthcare: From Price Transparency To Automation

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…

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3 Advances That Could Change Patient Care

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…

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Common coding problems, from unbundling to undercoding

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…

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Physicians unite to back cornerstone of Medicare pay overhaul

Months of high-level discussions regarding reforming Medicare physician payment has culminated in physician lawmakers introducing bipartisan legislation advancing the first leg of the AMA’s three-part strategy for fixing the broken…

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April 2023 OPPS Update Comes with New Codes and a New Identity

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…

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Lawmakers Want to Tie Physician Payment Updates to Inflation

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,…

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ACR Recommends Changes to Prior Authorization Proposed Rule

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…

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