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…
Medical billing is a process where you pay your provider for their services. When we say you, we mean that this is the process where your insurance carrier and you…
Following the Furthering Access to Stroke Telemedicine (FAST) Act, Medicare claims for telestroke services increased in rural and urban emergency departments. However, there was still substantial underbilling from hospitals with…
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…
The timeline for a U.S. transition to ICD-11 is still uncertain, it’s clear that planning for the transition to ICD-11 is underway. On Feb. 11, the World Health Organization (WHO)…
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…
The changes will become effective in about three months, giving providers time to modify processes. The staff at the Centers for Medicare & Medicaid Services (CMS) have been working overtime…
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…