In the wake of the COVID-19 pandemic, independent medical practices face many challenges, from adapting to new healthcare methods to major regulatory changes. The main focus of this study is to increase Medicare spending. With...
READ MORE->In the wake of the COVID-19 pandemic, independent medical practices face many challenges, from adapting to new healthcare methods to major regulatory changes. The main focus of this study is to increase Medicare spending. With...
READ MORE->2025 CMS Proposed Rule: Announcing this week a proposed rule for inpatient and long-term care hospitals (LTCHs) for the fiscal year of 2025 (FY), federal officials cited an increasing focus on social determinants of health...
READ MORE->Â Prior Authorization Reform, a lengthy and often frustrating process for payers to control costs, remains a major challenge for doctors. A recent AMA survey of 1,001 physicians found that 89% of physicians believe prior licensure...
READ MORE->It’s April, and that means it’s time for proposed rules for fiscal year 2025Â to emerge. But the Centers for Medicare and Medicaid Services (CMS) prevailed this year, releasing proposed rules for inpatient rehabilitation, psychiatric...
READ MORE->Streamlining Specialty Care: CMS’s Innovation Center prioritizes strategies that improve personalized healthcare information, implement financial services, and support segment-based classifications. A value-based approach to care must address underlying issues and individualized care to reduce patient...
READ MORE->CMS Interoperability and Prior Authorization Final Rule: On January 17, 2024, the Centers for Medicare and Medicaid Services (CMS) published the CMS Interoperability and Prior Authorization final rule (CMS-0057-F). The final rule aims to reduce...
READ MORE->Auditing Facility Services: Changes to evaluation and management (E/M) services in 2021 and 2023 have excited and confused auditors. I am glad that the seemingly trivial criteria required for the level of service (history, testing)...
READ MORE->Prior authorization transformation of consent is a source of worry and concern for everyone involved: patients, members, providers, and payers. What was needed was a structure to coordinate all stakeholders and organize the program. In...
READ MORE->Avoid authorization denials: Getting bogged down by authorization denials? You’re not alone. Here, we explore common roadblocks and effective strategies to keep your revenue flowing smoothly. Prior Authorization Denials: Challenge: Drowning in Last-Minute Authorizations Solution:...
READ MORE->Modifiers 52: Professional fee-for-service guidelines for modifiers do not apply in the clinical setting. Reduced, Failed, Aborted, Aborted… which one? What are the requirements for using modifiers 52, 73 and 74? These questions are common...
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