Category: Blog

CMS Proposes Patient-Driven Pay for Skilled Nursing Facilities

Skilled nursing facilities could face a new Medicare reimbursement system that pays based on patient conditions and needs, rather than volume of services provided. CMS recently proposed updates to several post-acute care prospective payment systems, with skilled nursing facilities seeing a potentially new Medicare reimbursement arrangement, called the Patient Driven Payment Model. The Patient Driven […]
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Medicare Reimbursement Cut For Stand-Alone Emergency Departments

Medpac Suggests Cutting Medicare Reimbursement For Stand-alone Emergency Departments The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the commission’s June 2018 report to Congress. MedPAC expressed concerns that stand-alone EDs in urban areas resulted in […]
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EHR’s To Drive Federal Health IT Spending To $8.1B By 2023

Dive Brief:​ Spending on vendor-provided federal health IT goods and services is estimated to increase from $6.1 billion this year to $8.1 billion in 2023, according to a Health IT News summary of a market outlook report. That increase will largely be driven by EHR projects at the Department of Defense and Veterans Affairs. Spending will top […]
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3 Tips To Take Your Denial Management Process To The Next Level

In the dynamic realm of medical billing, the persistence of denied claims poses a significant challenge for providers. Research indicates that an alarming portion of claims – exceeding 10% – face initial denial by insurance companies. This leads to revenue loss, wasted administrative efforts, and frustration for both providers and patients. A robust denial management […]
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Humana Adds 7 New States To Bundled Payment Portfolio

The Louisville-based Humana is expanding a value-based payment model into seven additional states, while the Medicare agency has yet to set a clear course for how to handle such models. Humana announced last week it would start offering its bundled payment model for hip and knee replacements under Medicare Advantage plans to members in Alabama, […]
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Look Ahead at ICD-10-CM Coding in 2018

The ICD-10-CM Tabular List of Diseases and Injuries 2018 Addenda provides insight to future diagnosis coding. Let’s review what is new, deleted, and revised in chapters 1-7. In future months, we will cover additional chapters. Chapter 1: Certain Infectious and Parasitic Diseases (A00-A09) Two codes are added under A04.7: A04.71 Enterocolitis due to Clostridium difficile, […]
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Ending the Aging Process: How to Control Your Accounts Receivable

When your reimbursement staff is working old accounts receivable while also trying to stay up-to-date with current billing and collection activity, they can quickly feel overwhelmed. While the high dollar claims always need to remain a priority, you also need to keep a watchful eye on aging claims to ensure that NOTHING is resolved past […]
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Multiple Procedure Payment Reductions (MPPR)

The multiple procedure payment reduction (MPPR) means that if a healthcare provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure. The reason is explained in Chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: Most medical and surgical […]
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