Category: Blog

Trump To Let States Divert Obamacare Funds To Other Health Plans

The Trump administration plans to allow states to direct billions of dollars of Obamacare subsidies to health plans that don’t meet the law’s requirements. Critics contend the new policy could undermine the ACA by driving up costs for some individuals. The change is intended to make insurance more affordable and expand consumer choice. Premiums for […]
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ICD-10 Coding: New Character Surfaces in Spinal Fusion Codes

Are there “Zs” in your spinal fusion coding? The fiscal year (FY) 2019 ICD-10-PCS updated an area that has not received much attention: Spinal fusion codes. During the Centers for Medicare & Medicaid Services (CMS) Coordination and Maintenance Committee meeting in September 2017, the topic of invalid spinal fusion codes was raised. There were spinal […]
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CMS to Launch Artificial Intelligence Health Outcomes Challenge

CMS is teasing a new cross-industry challenge to identify innovative strategies for using artificial intelligence to improve health outcomes. The CMS Innovation Center is gearing up to launch a new industry challenge aimed at identifying new strategies for leveraging artificial intelligence and machine learning to improve outcomes. The proposed challenge will explore how artificial intelligence […]
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2019 Physician Fee Schedule: Big Changes Ahead

No separate codes for podiatric E&M visits in final rule. The final rule for the 2019 Physician Fee Schedule was released on Nov. 1. Some of what was in the proposed rule was finalized, while other elements were either modified or completely eliminated. The proposal to reduce payment when evaluation and management (E&M) office and […]
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Mcare Appeals

Court Orders HHS to Eliminate Medicare Appeals Backlog by 2022

In light of new funding from Congress, HHS must reduce the Medicare appeals backlog according to annual deadlines and percentage amounts, a judge ordered. HHS must eliminate the Medicare appeals backlog at the Administrative Law Judge (ALJ) level by the end of the 2022 fiscal year, according to a recent court order. Judge James E. […]
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Denials

3 Tips To Manage Claims Denials At ASCs

Three experts on revenue cycle and operations at ASCs gathered at the Becker’s ASC 25th Annual Meeting: The Business and Operations of ASCs conference in Chicago Oct. 19 to discuss how administrators can improve reimbursement per case at their facilities. Here are three pieces of advice they shared on how to avoid claims denials: Be […]
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Collections

Cracking The Code Behind The Patient Revenue Cycle

The rules of other consumer commerce sectors somehow do not apply to medical billing. Stop and think about that for a moment. It’s easier to make sense of how much we spend for goods and services such as groceries, clothing, and gasoline because we know how much it costs up front. No smoke and mirrors. […]
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EM-Codes

E&M Flat Rate Reimbursement Delayed to 2021

For 2019 and 2020, we will see no changes to our outpatient, office-based evaluation and management (E&M) services, but things will change come 2021 – that according to the E&M Final Rule released Thursday by the Centers for Medicare & Medicaid Services (CMS). Since 2004, CMS has stated through the Claims Processing Manual that medical […]
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