A shortage of experienced nurses has hit the United States, particularly in rural communities, forcing many hospitals in the Midwest to recruit nurses from one another. One way hospitals have…
In the Medicare Advantage (MA) context, "risk adjustment" is the process by which the Centers for Medicare & Medicaid Services (CMS) reimburses Medicare Advantage Organizations (MAOs) based on demographic factors…
Once a year, the National Center for Health Statistics (NCHS), the federal agency responsible for the use of the International Classification of Diseases – 10th revision (ICD-10) in the US,…
Unfortunately, many healthcare providers are missing out on things like electronic billing, email capture. A new survey by the Medical Group Management Association suggests providers, especially hospitals, are missing out…
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…