A federal lawsuit claims that UnitedHealth Group, the largest Medicare Advantage insurer in the country, is coding medical claims inappropriately for monetary gain. But while the lawsuit doesn't involve physician…
A new government report finds that Medicare improperly paid acute care hospitals for outpatient services they provided to patients who were inpatients at other facilities. And now Medicare wants the…
Changes are coming with Evaluation and Management (E&M) coding guidelines. I will use this space to explain why these changes will be both a good thing and a challenge to…
Accurate, efficient revenue cycle management is essential to maintaining positive cash flow in a healthcare facility. Maintaining positive health care finances requires that claims processing and payments are effectively managed…
CMS released a proposed rule that would update the Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System. Here's what you should know about the ASC-related changes:…
It’s the most wonderful time of the year! That’s right, it’s back to school for the kiddos. As the hustle and bustle of the new school year starts and the…
Healthcare providers need to get paid to survive. This might be the most basic business 101 principle, so why do many companies – particularly health providers – still struggle to…
Overview On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient…
I often get the question, “What should my monthly numbers be?” My first response is, taking into account collections among other things affecting their practice, “What are your minimum requirements,…
Ohio doctors would report the specific diagnosis of every patient who receives a prescription painkiller under a tentative agreement reached Friday with the Kasich administration. The 11th-hour compromise between the…
It’s a change in nomenclature that’s come a bit out of the blue over the last few years. The forces appear to be aligning to gradually push the word “doctor”…
Implementation of an electronic health record-based prompt significantly increased hepatitis C screening rates among baby boomers in primary care. According to the researchers, HCV screening among adults born between 1945…
The U.S. Department of Justice (DOJ) arrested 412 individuals, including 115 licensed medical professionals, across the country for alleged involvement in health care fraud schemes totaling around $1.3 billion in…
The final codes include 322 more changes than what was proposed by CMS in April's hospital IPPS rule. Starting Oct. 1, it will be possible to select a specific ICD-10-CM…
• CPT code 99495 (TCM with moderate medical decision complexity and a face-to-face visit within 14 days of discharge) • CPT code 99496 (TCM with high medical decision complexity and…
Know when to apply these secondary codes. Foreign bodies (FBs) entering through one of the three ENT-specific pathways is a relatively common occurrence. While these situations are found primarily with…