The American College of Rheumatology (ACR) commended CMS for its proposed prior authorization policies but asked the agency to expand its guidance to other utilization management tools and shorten the…
From prior authorizations to paperwork, applications are being uncovered every day. I’m about to spice things up a bit here, but stick with me. “Chuck, I’m Sydney, and I’m in…
Outpatient visits are being billed at higher levels, leading to increased healthcare spending and concerns about upcoding, a Peterson-KFF Health System Tracker found. Healthcare providers can bill outpatient evaluation and…
Following a recent US District Court ruling on the federal government’s arbitration process for disputed medical billing—making the protocol for issuing decisions on disputed claims unclear—CMS posted some clarifying guidance…
One way to assess creativity in medicine is to look at how physicians are incorporating technology such as telehealth, virtual reality (VR) and augmented intelligence (AI), often called artificial intelligence, into…
CMS proposes new rules for 2024 that apply to Medicare Advantage Plans. Last month, I told you that there would be big news coming, and sure enough, there was. The…
The anticipated issue date for the new audit is the 2024 fiscal year. Citing “consistently high error rates,” federal officials announced this week that they will be conducting a nationwide…
The final rules become effective Jan. 1, 2023. Amid this election season, the Centers for Medicare & Medicaid Services (CMS) has published final rules for the 2023 Part B Physician…
Revised ICD-10-CM codes for neurocognitive disorders are now in effect, the American Psychiatric Association (APA) has announced The coding changes for major and mild neurocognitive disorders represent "the most consequential"…
New codes become effective Oct. 1, 2022. With the start of fiscal year (FY) 2023 right around the corner, this is a good time for clinical documentation integrity (CDI) professionals…
The Centers for Medicare and Medicaid Services has released the 2023 premiums, deductibles, and coinsurance amounts for fee-for-service Medicare Part A and Part B, and the 2023 Medicare Part D…
When commenting on the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule for calendar year (CY) 2023, the American Hospital Association (AHA)…
CMS has specific guidelines when defining “incident to” and shared visits. Recently, I was working with a client to help them understand “incident to” billing. We were discussing a situation…
The rise of telehealth during the COVID-19 pandemic pushed up the timetable on telehealth education for medical schools and residency programs. But the relative lack of training using this newer…
Time for CDI checkup. Clinical Documentation Integrity (CDI) programs may be exposing hospitals to unnecessary, costly compliance risks and financial exposure by virtue of their very nature and purpose. When…
Doctors can use a government database to compare their practice patterns to others across the nation, says a former Wall Street trader turned physician. The database, maintained by the Centers…