Following a recent US District Court ruling on the federal government’s arbitration process for disputed medical billing—making the protocol for issuing decisions on disputed claims unclear—CMS posted some clarifying guidance…
CMS proposes new rules for 2024 that apply to Medicare Advantage Plans. Last month, I told you that there would be big news coming, and sure enough, there was. The…
When commenting on the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule for calendar year (CY) 2023, the American Hospital Association (AHA)…
CMS has specific guidelines when defining “incident to” and shared visits. Recently, I was working with a client to help them understand “incident to” billing. We were discussing a situation…
The American Medical Association has issued a category III current procedural terminology code for Figur8's sensor fusion system combining inertial measurement system and surface mechanomyography. The device was designed to…
Time for CDI checkup. Clinical Documentation Integrity (CDI) programs may be exposing hospitals to unnecessary, costly compliance risks and financial exposure by virtue of their very nature and purpose. When…
Doctors can use a government database to compare their practice patterns to others across the nation, says a former Wall Street trader turned physician. The database, maintained by the Centers…
When it comes to usability, doctors give electronic health record (EHR) systems an “F”. And that poor usability correlates with physician burnout, according to a study published today in Mayo…
In 2021, the Centers for Medicare & Medicaid Services (CMS) issued guidance to emphasize the importance of social, economic, and environmental factors that can affect the health outcomes of disadvantaged…
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any…
Medical billing and coding is one of the hottest medical professions in great demand with a great deal of job opportunities and rooms for promotion. Promotion will come with increment…
Some flareups may lead to readmissions within 30 days. We can all agree that we want to fully treat our patients’ acute problems that require inpatient hospitalization, allowing them a…
You might know that medical billing is a challenging process. That’s the reason why many people make several mistakes in this case. If you have the same problem, you can…
CMS has released its Hospital Inpatient Prospective Payment System (IPPS) proposed rule for fiscal year 2023, which includes a payment rate boost for general acute care hospitals and new measures…
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…
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…