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…
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 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…
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…
CMS announced it would be reinstating the COVID-19 healthcare worker vaccine mandate to facilities in 25 states and the District of Columbia that are not affected by the preliminary injunction. The states…
Changes to the MPFS, OPPS, and HHPPS were announced on the same day. Rather than a “news dump” late on a Friday afternoon, federal healthcare officials instead served up a…
CMS has officially rescinded a final rule published by the Trump Administration that would have expedited the Medicare coverage process for breakthrough devices. The agency said it will take a…
CMS says it the goal is to support health equity while focusing on high-quality person-centered care. Increased leverage of telehealth for behavioral care, diabetes prevention and mitigation, and enhanced payment…
Various approvals, exceptions, and new PCS codes that may potentially lead to additional payments. The Centers for Medicare & Medicaid Services (CMS) desires to use the best data available when…
Everyone in the industry knows about audits of healthcare providers. But what about the billing companies? Or a data-analytics company? In a complaint filed last week, a New York data-mining…
CMS has requested that Medicare Advantage organizations relax or waive prior authorizations due to the impact of the coronavirus Delta variant. “The ability of hospitals to transfer patients to appropriate…
In the world of healthcare regulation, when it rains, it pours – but then occasionally, like last week, we get a drought. Last week, the Centers for Medicare & Medicaid…
States that expanded Medicaid in 2014 saw a 45 percent decline in the mean flow of medical debt collections compared to states that chose not to expand Medicaid or those…
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,…
Remote patient monitoring may be catching on with health systems across the country, but its path to Medicare reimbursement is still a work in progress. The Centers for Medicare &…