Medical necessity guidelines must also be carefully reviewed for their applicability to the individual patient. The term “medical necessity” is used far and wide in medical care. But medical necessity…
Many nursing home COVID-19 patients would have benefited from daily, reimbursed-for physician visits in their skilled nursing facilities, but they were not entitled to them. With an epic crisis still…
Proposed rules offer insight into the Administration’s priorities. The Centers for Medicare & Medicaid Services (CMS) has issued its first proposed payment rules under the Biden Administration. While these rules…
With dwindling provider availability and a growing patient population, the healthcare industry is increasingly turning to technological advancements to improve patient outcomes. During the pandemic, the industry was forced to…
By April of last year, seemingly every news station in American was featuring the heroic efforts of physicians, nurses, and other clinicians fighting COVID-19. These providers transformed healthcare, implementing telehealth…
Providers should be aware of these emerging strategies for defending against audits. For years, providers have been plagued with defending claims for medically necessary services that have been denied due…
There are certain key elements of consideration during CDI review of COVID-19 patients. Understanding how to clinically validate sepsis and differentiate between sepsis and septicemia is not easy, and requires…
Skilled nursing facility (SNF) staffing levels across several provider types have fallen since Medicare implemented new payment rules meant to drive value over volume of services, according to a new…
Inpatient hospital stays have become more expensive to the Medicare program. It's a trend that began even before the COVID-19 pandemic. A new report from the Department of Health and…
The Medicare IPO list was doomed years ago. For readers of and listeners to RACmonitor and Monitor Mondays, overthinking things is what we do. It’s the only explanation for our…
Pay attention to dates associated with the new COVID--19 codes, Z20.822 and Z20.828, to avoid billing errors. In December 2020, the Centers for Disease Control and Prevention (CDC) announced six…
New Current Procedural Terminology (CPT®) codes have been created that streamline the novel coronavirus testing currently available on the United States market. New codes for immunizations CPT codes have been…
Knee ligaments connect the bones and cartilage, and hold and support the knee joint. Any mild tear in ligaments may severely limit the movement of the knees. Most commonly occurring…
With COVID-19 vaccinations now being administered across the United States, we have compiled this list of medical code sets to account for the treatment and vaccinations for the novel Coronavirus.…
While some have said medical coding sits quietly in the middle of the healthcare revenue cycle, it is a key step that, when done inadequately, can impact each part of…
Estimated savings are $75 million over a decade. Federal officials recently announced a series of changes to the Medicare Advantage (MA) and Part D prescription drug programs they hope will…