Question: Why do my Evaluation & Management (E&M) codes keep getting denied when I bill them in conjunction with spinal manipulation? I have been receiving increasing inquiries regarding the denial of Evaluation and Management (E&M)...
More InfoCMS is proposing changes and a three year extension to the Comprehensive Care for Joint Replacement Model (CJR), which provides a flat set of payments to hospitals for an episode of care through 90 days past patient discharge. The program was due...
More InfoFor the past several decades, patients, providers, and payers have lamented the health of the U.S. healthcare system. Just this past fall, JAMA: The Journal of the American Medical Association, estimated that close to 30% of healthcare spending...
More InfoThe American Hospital Association has filed a lawsuit to block the rule. On Nov. 15, 2019, the Trump Administration proposed a new healthcare price transparency rule that would basically require hospitals to explain how much a medical service...
More InfoThe Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage plan (MA, or Part C) and the Medicare prescription drug benefit (Part D) program. In years past, CMS has also issued a “call...
More InfoIn November 2019, CMS published the 2020 Quality Payment Program Final Rule (the “2020 MIPS Final Rule Changes”). Below is a summary of some of the most notable changes to the Merit-Based Incentive Payment Program (MIPS). For a complete list of...
More InfoED professional codes are typically assigned by professional coders with specialized training in emergency medicine coding. The CPT® code set, including ED code descriptors and applicable rules, guide this choice based on the documented history...
More InfoPhysicians will potentially have a lighter documentation burden and more time to spend with patients in 2021 thanks to an overhaul of Medicare Coding guidelines for outpatient evaluation and management (E/M) services. “The whole point was to have...
More InfoAs the U.S. responds to a growing threat of the 2019 novel coronavirus, CMS and other organizations are clarifying how to code for testing and treatment of the disease. Six things to know: 1. CMS created a new Healthcare Common Procedure Coding...
More InfoPrior authorizations, or prior approvals, are strategies that payers use to control costs and ensure their members only receive medically necessary care. The cost-control process requires providers to acquire advance approval from payers before...
More InfoImproving data analytics in healthcare has potential includes cost savings and improved patient health and wellness. Here are the two ways through which this improvement can be accomplished: Adopt a business analytics strategy that process huge...
More InfoMuch of the buzz you hear about artificial intelligence (AI) or machine learning (ML) in healthcare is about its clinical applications, whether assisting doctors with diagnoses or customizing cancer treatment plans. But healthcare is a big...
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