Over the last few years, healthcare has shifted from a standardized, product-centric experience to one that is more personalized. Patients now have access to more information on providers than ever, meaning they have more choice when selecting care they feel will best meet their unique needs. At the same time, patients are taking on more […]
MAs are taking advantage of excessive denials to reduce payments to providers. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently found that between 2014 and 2016, a total of 75 percent of all appealed Medicare Advantage (MAs) denials were overturned, equivalent to roughly 216,000 denials a year. I […]
There are numerous patient engagement strategies aimed at improving care. What are the outcomes that show these solutions are working? Patient engagement affects every patient interaction across the care continuum. Accordingly, the outcomes that you can expect will come from every area of the organization. When refining targeted outcomes, let metrics be your guide. Measurement […]
Claim denial prevention and management is crucial for a hospital’s financial health. Without an effective approach, organizations may lose or experience delays with reimbursement. A Change Healthcare study found a typical health system could lose as much as 3.3 percent of net patient revenue, an average of $4.9 million per hospital, due to denials. That’s […]
CMS proposes to ease burdens on providers. When it comes to the ever-changing Centers for Medicare & Medicaid Services (CMS) agency rules and regulations, one can’t help but be reminded of the classic tune by The Byrds: “to everything (turn, turn, turn), there is a season (turn, turn, turn).” The last several decades have been […]
Nearly all healthcare decision makers recently surveyed by KLAS said their organization saw financial gains after implementing a clinical documentation improvement solution. Provider organizations are seeing financial improvements after implementing clinical documentation improvement (CDI) solutions, a recent KLAS survey shows. Revenue improved for about 53 percent of healthcare executives, medical records directors and managers, and […]
Loading up MIPS reporting on one of three performance categories can help eligible clinicians prevent a negative payment adjustment in 2020, the AMA found. Eligible clinicians can avoid a financial penalty under the Merit-Based Incentive Payment System (MIPS) in 2020 by focusing their reporting on one of three performance categories: Quality, Improvement Activities, or Promoting […]
Hurricane Florence, described as an “extremely dangerous” Category 4 hurricane, was headed for the southern North Carolina coast. In a written statement to RACmonitor, Atrium Health, formerly Carolinas Healthcare System, said that its teams “remain focused on the safety of our employees, the coordination of resources across affected healthcare facilities, and most importantly, our commitment […]
Proposed changes to payments for evaluation and management (E/M) codes do not appropriately recognize the value of cognitive care required to treat complex patients, and the proposal should not be implemented, says the American College of Physicians (ACP). The changes are part of the proposed 2019 Medicare Fee Schedule (MFS) and Quality Payment Program (QPP) […]
There were many code revisions with guidelines, descriptions and instructional note changes. There six new codes in the Evaluation and Management (E&M) section in CPT. Guidelines were revised for Interprofessional Telephone/Internet/Electronic Health Record Consultations. New codes 99451 and 99152 were added to report assessment and management services. The codes are based on medical consultative […]