Category: Blog

Typical post-operative care, including related evaluation and management is not separately reportable; but, an unrelated evaluation and management service during a postoperative period may be. According to the Centers for Medicare and Medicaid Services (CMS), an E/M service provided during the global period of a procedure is unrelated if: The E/M service is for treatment […]

Change to the inpatient admission order considered to be major. The Centers for Medicare & Medicaid Services (CMS) released the Inpatient Prospective Payment System Final Rule, which becomes effective on Oct. 1. It’s 2,593 pages, so get reading. I have to commend the CMS staff for their work on this rule. I know few of […]

The big question for many who are new to running and operating an urgent care clinic is how to continue being profitable during a slow flu season in a very competitive market. There are eight key tips urgent care clinics can follow to optimize revenue and remain profitable. 1. Improve RCM: Effective revenue cycle management […]

Medicare claims that do not meet date format requirements will be rejected. The Centers for Medicare & Medicaid Services (CMS) has released date formatting guidelines for the CMS-1500 claim form, which are effective for claims received on or after July 30. When date formatting requirements are not met, Medicare Administrative Contractors will return claims as […]

The CMS’ proposed Medicare Physician Fee Schedule for 2019 includes changes to the quality payment program and a slight increase in the anesthesia conversion factor. Here’s what you need to know: The national conversion factor for anesthesia services will see an increase from $22.1887 to $22.2986. The increase includes the 0.25 percent positive and budget […]

You’ve seen the headlines splashed on TV and across the internet: data breaches hit national businesses such as Target, Chipotle, and many large healthcare systems. But data breaches don’t just affect large corporate entities, they affect small healthcare organizations as well. Take the case of Holland Eye Laser Surgery in March 2018. Their five-provider group […]

Artificial intelligence can alleviate revenue cycle management challenges About 64 million adults in America struggle to pay their medical bills. In fact, one in five Americans is considered to have delinquent medical debt. As high-deductible health plans (HDHPs) have grown in popularity over the past couple of years, patient financial responsibility continues to increase, making […]

Understanding the terms and provisions in a payer contract is key to maximizing reimbursement, preventing denials, and operating a smooth revenue cycle. Providers are in the business of keeping their patients healthy. But confusing payer contracts riddled with “legalese” and other complicated provisions can get in the way of improving patient outcomes. Payer contracts define […]

The Centers for Medicare & Medicaid Services (CMS) is modifying its Medicare coverage policy for continuous glucose monitors (CGMs) to support their use in conjunction with smartphones, including the data sharing function CGMs provide. Medicare coverage of therapeutic CGMs began in January 2017, but the policy limited their use in conjunction with smartphones. CMS is […]

A decade ago, CMS enacted Hospital Inpatient Prospective Payment System (IPPS), a policy that penalizes hospitals for hospital-associated conditions (HAC) not present during admission. Recent research published in Infection Control & Hospital Epidemiology has shown the program has had minimal impact on hospital reimbursement. The researchers also found associated billing codes were “rarely used” by […]