In a recent study posted to the medRxiv* preprint server, researchers evaluated the use of U09.9, an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code described as 'Post…
Hospitalizations appear to be more complex, requiring greater attention from the multidisciplinary team. As we know, with the growth of outpatient surgical centers, advances in medical technology, and the shift…
The average cost of debunking a denial is $25 per claim, not to mention the continuous challenges associated with attaining timely payment. Reviewing denial management strategies on a regular basis…
Providers are bracing for the end of government funds to administer COVID-19 vaccines. Starting Tuesday, April 5, the Department of Health and Human Services will no longer adjudicate claims submitted…
The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) initiative is a new model for ACOs operating under Medicare. It will be tested under the Centers for…
The American Medical Association (AMA) recently announced three new CPT codes for administration of Pfizer’s COVID-19 vaccine in children 6 months to under 5 years old, JustCoding reported. The new product and…
1. Guidelines changes to frequently used outpatient evaluation and management (E/M) billing use have changed the types of billing codes used within 4 months of implementation. 2. Despite being the…
Providers would do well to think beyond any specific national standard, to more specific details, when considering denial appeals. A member of a message board I follow, and to which…
In an ideal world, the healthcare industry would be the perfect arena for unleashing the transformative potential of artificial intelligence. Sophisticated AI models require vast amounts of data to learn from, and…
COVID-19’s omicron surge is loosening its grip on many of the country’s hospitals, leading several states to relax mask requirements and other restrictions. According to Centers for Disease Control and…
Healthcare digitization, including increased use of telehealth and EHR has led to a higher volume of healthcare fraud and False Claims Act (FCA) cases, according to lawyers from Hogan Lovells.…
COVID-19 has spurred innovation and growth, including the trend toward outpatient care at office-based labs. As a result of increased calls to keep patients out of the hospital and safe…
RACmonitor launches an occasional series, “RAC Rants,” with this first post by past president of the Healthcare Business and Management Association (HBMA) Holly Louie. Entries are welcome at editor@medlearnmedia.com. The…
These codes are time-based CPT codes, used to report care management activities during a calendar month. The Centers for Disease Control and Prevention (CDC) reports that 6 in 10 Americans…
OIG's decision to perform a nationwide audit examining compliance with the Provider Relief Fund's balance billing restriction comes just weeks after new federal rules designed to shield consumers from unexpected…
Telemedicine billing was challenging and confusing even before the COVID-19 pandemic thrust remote healthcare into the mainstream. Now, telemedicine is changing healthcare and evolving daily, making telemedicine billing a moving…