I recently saw a notable update on the Trusted Exchange Framework and Common Agreement or TEFCA, a federal program intended to improve health data interoperability across the healthcare industry. …
CPT code +69990 Microsurgical techniques requiring use of operating microscope is assigned when a surgeon uses an operating/surgical microscope to aid in visualizing small/fine structures in the operating field during…
The Centers for Medicare & Medicaid Services (CMS) has proposed an episodic payment model, the Transforming Episode Accountability Model (TEAM). This is one of CMS’s “innovation” models. If it makes…
Provider compensation is still on the rise after the COVID-19 pandemic, according to the latest data from the Medical Group Management Association (MGMA). For the fourth consecutive year, MGMA recorded…
As part of the Jan. 1, 2024 Outpatient Prospective Payment System (OPPS) guidelines, caregiver training services (CTS) codes were listed as billable services if provided by physicians and non-physician practitioners…
Medical experts have put on hold a proposal to create new billing codes for prior authorizations. The American Medical Association’s CPT (current procedural terminology) Editorial Panel was scheduled to meet…
Medicare Advantage plans have come under fire for upcoding that can increase the payouts they receive, and regulators point to health risk assessments as a likely culprit in this increase…
The rapid adoption of telehealth services, accelerated by the COVID-19 pandemic, has had a positive result on outcomes and resulted in a boost in healthcare spending, according to a report…
A recent study from the healthcare solutions company Premier indicated that $19.7 billion is what hospitals and health systems are spending annually on handling and appealing denials. Yes, that is…
The Centers for Medicare & Medicaid Services (CMS) has issued its 2025 Inpatient Prospective Payment System (IPPS) Proposed Rule, through which it proposes to change the severity designation for several…
When it comes to healthcare policy, even seemingly minor adjustments can have significant ripple effects across the industry. The Centers for Medicare & Medicaid Services (CMS) recently unveiled its proposed…
One of the goals of medical coding is documenting encounter notes to the highest degree of specificity. ICD-10-CM had some existing codes for documenting foreign bodies entering through a natural…
The Star Rating program for hospitals summarizes quality information on important topics, like readmissions and mortality, after admissions for conditions such as myocardial infarction (MI) or pneumonia. The overall ratings…
The American Hospital Association is asking the Centers for Medicare and Medicaid Services to crack down on Medicare Advantage insurers it says are blatantly flaunting CMS coverage rules. "We expressed…
Recent changes to the minimum data set (MDS) assessment and recent audit activity targeting skilled nursing facilities (SNFs) appear to be an emerging issue. As a reminder, the MDS assessment…
Federal policy makers aim to revise the billing dispute resolution process in the No Surprises Act (NSA). The administration of President Joe Biden and the U.S. Departments of Health and…