The bill would aim to standardize processes and require greater oversight on Medicare Advantage plans’ utilization and denial of prior authorizations. Better Medicare Alliance (BMA) has endorsed HR 3173, the Improving Seniors’ Timely Access to Care Act, a law that seeks to reform prior authorization in Medicare Advantage. “When it comes to the use of […]
Healthcare spending could drop by more than $11.4 billion next year if enhanced premium tax credits enacted in the American Rescue Plan expire, new research finds. Hospital spending would decline by $3.8 billion, while spending on physician practice services would drop by $1.3 billion, according to a report from the Robert Wood Johnson Foundation and […]
The organization recommended CMS update the independent dispute resolution portal to improve communication between disputing parties and adjust the form field requirements. The Medical Group Management Association (MGMA) has asked CMS to update the federal independent dispute resolution (IDR) portal to streamline the arbitration process for determining an out-of-network payment rate for a surprise medical […]
The No Surprises Act came into effect in December 2021, potentially averting countless instances of unexpected billing claims within its initial two months of implementation. By May 24, 2022, the No Surprises Act had already thwarted over two million cases of surprise billing claims during its initial two-month span, as per a survey conducted by […]
More than 400 healthcare finance leaders reported having revenue cycle workforce shortages, with almost 20 percent seeing 30 or more vacancies. Healthcare finance leaders are experiencing revenue cycle workforce shortages, with one in four reporting that they need to hire more than 20 employees to fully staff their department, according to a survey commissioned by […]
Payment integrity in Medicaid—the concerted effort to keep tight control over fraud, waste and abuse—can be addressed at any stage in the claim cycle. Of course, the earlier it is addressed, the easier it is for health plans to avoid improper payments and the administrative burden of recovering them. And while pre-payment integrity programs maximize […]
While the Moderna COVID-19 vaccine for young children has yet to receive FDA authorization, AMA has created a CPT code to ensure healthcare professionals are prepared for the shot’s potential use. The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include CPT codes for the Moderna COVID-19 vaccine for […]
Limit this code to administration of the Pfizer-BioNTech vaccine. On May 17, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to authorize the use of a booster dose for patients 5 through 11 years of age. The CPT® code to report administration of this […]
On April 29, 2022, the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). CMS promotes the Final Rule as advancing “CMS’ strategic vision of expanding access to affordable health care […]
A focus on front-end revenue cycle efficiency can help to avoid costly medical necessity denials. KEY TAKEAWAYS Four words often describe the efforts to prevent denials related to medical necessity: too little, too late. Mistakes are made early in the patient’s hospital stay, and these mistakes lead to problems down the road. What remains constant […]