In a recent study posted to the medRxiv* preprint server, researchers evaluated the use of U09.9, an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code described as 'Post…
CMS has released its Hospital Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year 2023, which includes a payment rate boost for general acute care hospitals and new measures…
Hospitalizations appear to be more complex, requiring greater attention from the multidisciplinary team. As we know, with the growth of outpatient surgical centers, advances in medical technology, and the shift…
The average cost of debunking a denial is $25 per claim, not to mention the continuous challenges associated with attaining timely payment. Reviewing denial management strategies on a regular basis…
Providers are bracing for the end of government funds to administer COVID-19 vaccines. Starting Tuesday, April 5, the Department of Health and Human Services will no longer adjudicate claims submitted…
The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) initiative is a new model for ACOs operating under Medicare. It will be tested under the Centers for…
The American Medical Association (AMA) recently announced three new CPT codes for administration of Pfizer’s COVID-19 vaccine in children 6 months to under 5 years old, JustCoding reported. The new product and…
Medical billing is a process where you pay your provider for their services. When we say you, we mean that this is the process where your insurance carrier and you…
Following the Furthering Access to Stroke Telemedicine (FAST) Act, Medicare claims for telestroke services increased in rural and urban emergency departments. However, there was still substantial underbilling from hospitals with…
1. Guidelines changes to frequently used outpatient evaluation and management (E/M) billing use have changed the types of billing codes used within 4 months of implementation. 2. Despite being the…
Providers would do well to think beyond any specific national standard, to more specific details, when considering denial appeals. A member of a message board I follow, and to which…
The timeline for a U.S. transition to ICD-11 is still uncertain, it’s clear that planning for the transition to ICD-11 is underway. On Feb. 11, the World Health Organization (WHO)…
In an ideal world, the healthcare industry would be the perfect arena for unleashing the transformative potential of artificial intelligence. Sophisticated AI models require vast amounts of data to learn from, and…
COVID-19’s omicron surge is loosening its grip on many of the country’s hospitals, leading several states to relax mask requirements and other restrictions. According to Centers for Disease Control and…
The changes will become effective in about three months, giving providers time to modify processes. The staff at the Centers for Medicare & Medicaid Services (CMS) have been working overtime…
Healthcare digitization, including increased use of telehealth and EHR has led to a higher volume of healthcare fraud and False Claims Act (FCA) cases, according to lawyers from Hogan Lovells.…