On July 13, 2021, CMS released the 2022 Medicare Physician Fee Schedule Proposed Rule (Proposed Rule). In addition to the standard proposals related to rate setting for the coming year,…
The federal government is increasingly levying enforcement actions against health-care providers. For example, in fiscal year 2010, the federal government initiated 378 civil actions and 647 criminal actions, as compared…
The effective date for the FY 2022 Official Guidelines is Oct. 1, 2021 Released earlier in the year than in the past, the Official Guidelines for Coding and Reporting of…
Modern medical billing activities are complex, and it may take months to process a bill. Most issues crop up from internal workflow with demands forced by claims processing sellers as…
The billing Code 44 and the required UR process have become intertwined. Utilization review teams and physician advisors have the same goal as the Centers for Medicare & Medicaid Services…
OSHA has issued an Emergency Temporary Standard (ETS) for occupational exposure to COVID-19 that is applicable only to healthcare employers. The genesis for this ETS came one day after President…
The underlying etiology is sequenced first and the manifestation, or the presentation of the disease process, is coded second. Recently I was listening to a podcast called Coder vs. CDI…
Refinements continue for the evaluation and management (E/M) office-visit and outpatient documentation and coding reforms that took effect this year, and these include technical corrections updates to the Current Procedural…
The present world which we are working at right now is completely filled with far more opportunities to turn up everything right for ourselves. When we are progressing just in…
Medical necessity guidelines must also be carefully reviewed for their applicability to the individual patient. The term “medical necessity” is used far and wide in medical care. But medical necessity…
Many nursing home COVID-19 patients would have benefited from daily, reimbursed-for physician visits in their skilled nursing facilities, but they were not entitled to them. With an epic crisis still…
With dwindling provider availability and a growing patient population, the healthcare industry is increasingly turning to technological advancements to improve patient outcomes. During the pandemic, the industry was forced to…
By April of last year, seemingly every news station in American was featuring the heroic efforts of physicians, nurses, and other clinicians fighting COVID-19. These providers transformed healthcare, implementing telehealth…
Providers should be aware of these emerging strategies for defending against audits. For years, providers have been plagued with defending claims for medically necessary services that have been denied due…
There are certain key elements of consideration during CDI review of COVID-19 patients. Understanding how to clinically validate sepsis and differentiate between sepsis and septicemia is not easy, and requires…
Skilled nursing facility (SNF) staffing levels across several provider types have fallen since Medicare implemented new payment rules meant to drive value over volume of services, according to a new…