In countries like the US, citizens are investing in health insurance plans, which are directly increasing the demand for medical coders’. Recently got an opportunity to interact with a few…
Prior authorizations consume hours of physician time as they seek insurer approval for drugs and treatments. Health plans say prior auths improve the quality of care and manage healthcare spending,…
CMS has provided ICD-10 Procedure Coding System updates for the fiscal year beginning Oct. 1, 2019, and ending Sept. 30, 2020. Four takeaways: 1. The updated ICD-10-PCS codes are for…
The case continues even after two suicides. When does an audit go beyond the reasonable and become persecution? An act of tyranny by claim denial and extrapolation? Vernon Partners LLC…
There are 2,115 additions to the third quarter Medicare National Correct Coding Initiative (NCCI or CCI) practitioner edits that became effective July 1, 2019. The good news is that the…
The stories of Americans affected by surprise medical bills are hard to believe. A teacher with insurance was taken to an out-of-network medical facility when he suffered a heart attack…
On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services…
As the industry grapples with solutions for high patient financial responsibility and healthcare costs, it has become laser-focused on one key, unifying issue: surprise medical billing. A surprise medical bill…
Where the burden lies could make a difference when it comes to the RACs. In a legal lawsuit, one party is initially presumed to be correct and gets the benefit…
Tina R. Strawn, RN, administrative director of operations for patient financial services at Houston-based Harris Health System, has 27 years of healthcare experience. Throughout her career, she has worked in…
It’s every physician’s worst nightmare: Receive payment for services rendered, but then a payer identifies an aberrant pattern in claims data, audits the records, decides it has overpaid the practice,…
Another day, another change to E/M plans for 2021! Medicare has released the 2020 proposed rule for the Medicare Physician Fee Schedule (MPFS), bringing in the recent AMA plan to…
Five areas of concern are noted by the author. In the first part of this series, we examined audit risks associated with observation claims. We should review what other risk…
Concerns are related to observation claims. By now just about everyone has surely heard about Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma’s blog post on May 2,…
The American Medical Association is giving high marks to a proposal by the Centers for Medicare and Medicaid Services to reduce the burden of Evaluation and Management codes on physicians.…
The rising cost of health care in this country puts millions of Americans at risk. One of the many issues that Congress can and should address to help improve this…