Midland Memorial Hospital agreed to pay over $555,000 for a medical coding error that resulted in claims being sent out for reimbursement from the government even though patients did not…
Outdated billing practices, particularly in hospitals and physician offices, are causing some issues for debt collection firms as they revamp their consumer communication practices as required by law, Bloomberg Law…
Various approvals, exceptions, and new PCS codes that may potentially lead to additional payments. The Centers for Medicare & Medicaid Services (CMS) desires to use the best data available when…
Physician groups are now permitted to subdivide into groups of at least five physicians apiece – and that’s the root of the problem. One of the provisions in the changes…
Everyone in the industry knows about audits of healthcare providers. But what about the billing companies? Or a data-analytics company? In a complaint filed last week, a New York data-mining…
Both providers and payers have major concerns with how regulations to ban surprise medical bills will be implemented next year, with providers concerned about added burden and insurers clamoring for…
Innovative work to meet the urgent public health need for streamlined reporting and tracking of COVID-19 vaccinations is presented in today’s release of the 2022 Current Procedural Terminology (CPT®) code…
The CMS budget for fraud, waste and abuse has doubled in size from 2021 to 2022. Two years ago, the federal government created a plan to audit Medicare Advantage (MA) insurers more…
CMS has requested that Medicare Advantage organizations relax or waive prior authorizations due to the impact of the coronavirus Delta variant. “The ability of hospitals to transfer patients to appropriate…
Research shows that about 14 percent of adults developed at least one new clinical sequela requiring medical care after recovery from COVID-19, though many specifics have yet to be clarified.…
Your practice is considering making a move—or has moved—to a collaborative care model so patients have greater access to mental health care in the primary care setting. It’s a model…
Despite skepticism, artificial intelligence (AI) can be a boon for physicians…but some improvements are needed first. Notably, AI algorithms need to be validated, and bias toward particular groups of patients…
In the world of healthcare regulation, when it rains, it pours – but then occasionally, like last week, we get a drought. Last week, the Centers for Medicare & Medicaid…
Protect the integrity of your practice’s medical records with this sage advice. Evaluation and management (E/M) services are likely the most regulated and most often audited services in medical practices.…
States that expanded Medicaid in 2014 saw a 45 percent decline in the mean flow of medical debt collections compared to states that chose not to expand Medicaid or those…
On July 13, 2021, CMS released the 2022 Medicare Physician Fee Schedule Proposed Rule (Proposed Rule). In addition to the standard proposals related to rate setting for the coming year,…