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…
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…
Telemedicine billing was challenging and confusing even before the COVID-19 pandemic thrust remote healthcare into the mainstream. Now, telemedicine is changing healthcare and evolving daily, making telemedicine billing a moving…
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…
The New York State Department of Financial Services wants health insurers to pay any extra bills when their out-of-date provider directories send patients to out-of-network doctors and hospitals. The state…
In the year and a half following the Affordable Care Act’s first marketplace open enrollment period, the number of families who had trouble paying medical bills decreased by nearly 10…
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…
Outdated billing practices, particularly in hospitals and physician offices, are causing some issues for debt collection firms as they revamp their consumer communication practices as required by law, Bloomberg Law…
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…
Innovative work to meet the urgent public health need for streamlined reporting and tracking of COVID-19 vaccinations is presented in today’s release of the 2022 Current Procedural Terminology (CPT®) code…
The CMS budget for fraud, waste and abuse has doubled in size from 2021 to 2022. Two years ago, the federal government created a plan to audit Medicare Advantage (MA) insurers more…
Your practice is considering making a move—or has moved—to a collaborative care model so patients have greater access to mental health care in the primary care setting. It’s a model…
Despite skepticism, artificial intelligence (AI) can be a boon for physicians…but some improvements are needed first. Notably, AI algorithms need to be validated, and bias toward particular groups of patients…
Protect the integrity of your practice’s medical records with this sage advice. Evaluation and management (E/M) services are likely the most regulated and most often audited services in medical practices.…