On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services…
As the industry grapples with solutions for high patient financial responsibility and healthcare costs, it has become laser-focused on one key, unifying issue: surprise medical billing. A surprise medical bill…
Where the burden lies could make a difference when it comes to the RACs. In a legal lawsuit, one party is initially presumed to be correct and gets the benefit…
Tina R. Strawn, RN, administrative director of operations for patient financial services at Houston-based Harris Health System, has 27 years of healthcare experience. Throughout her career, she has worked in…
It’s every physician’s worst nightmare: Receive payment for services rendered, but then a payer identifies an aberrant pattern in claims data, audits the records, decides it has overpaid the practice,…
Another day, another change to E/M plans for 2021! Medicare has released the 2020 proposed rule for the Medicare Physician Fee Schedule (MPFS), bringing in the recent AMA plan to…
Five areas of concern are noted by the author. In the first part of this series, we examined audit risks associated with observation claims. We should review what other risk…
Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2,…
The American Medical Association is giving high marks to a proposal by the Centers for Medicare and Medicaid Services to reduce the burden of Evaluation and Management codes on physicians.…
The rising cost of health care in this country puts millions of Americans at risk. One of the many issues that Congress can and should address to help improve this…
What’s the news: New proposals that prioritize patients over paperwork and let doctors be doctors by reducing administrative burdens—including simplifying coding for evaluation-and-management (E/M) office visit services—were released this week…
The ICD-10 codes associated with head CT examinations do not accurately reflect patient complexity, according to a new study published in Current Problems in Diagnostic Radiology. This discrepancy, the authors…
Advance-care planning (ACP) is the keystone of goal-concordant care, enabling patients to state their treatment preferences while they still have the mental capacity to do so. The Centers for Medicare…
Many readers may remember the Centers for Medicare & Medicaid Services (CMS) Transmittal 534. This was released in early August 2014, and it would have given Medicare contractors the ability…
A new collaboration between the AMA and UnitedHealthcare will work to address the social and environmental factors that affect patients’ health by standardizing data collection on their social determinants of…
Modifiers are the key to overriding Correct Coding Initiative (CCI) edits, so let’s give them the attention they deserve. We’ll start with a recent rule update and move on to…