Category: Blog

Pushing Back Against Medicare Advantage SNF Denials

Pushing Back Against Medicare Advantage SNF Denials: Part 1

Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
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CHIPS in CMS-2439-P

Know About “CHIPS” in Proposed Rule CMS-2439-P

The Children’s Health Insurance Program (CHIP) was established under the Balanced Budget Act of 1997 (BBA 97) to offer health insurance to children from low to moderate-income families who were ineligible for Medicaid but couldn’t afford private insurance. The program grants federal funding to states, enabling them to establish and enhance their own programs, and […]
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Three Strategies for Streamlining Denials Management

Three Strategies for Streamlining Denials Management

Revenue cycle leaders continue to face significant stress due to regulatory burdens and persistent denials, which are exerting immense pressure on revenue cycles. Despite having a well-functioning front, middle, and back-end revenue cycle, payers often disrupt the process by introducing complexities and constantly changing rules within their intricate, multi-tiered structures. This unpredictable behavior from payers […]
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New Healthcare AI Tools

New AI Tools for Efficient Billing and Enhanced Testing

The integration of artificial intelligence into health IT vendor offerings for provider operations, medical testing, patient engagement, and various other use cases has led to a remarkable pace of innovation in the industry. AI-Powered Billing Assistants Seattle-based Healthtech company, established in 2021, made an announcement on Tuesday regarding the expansion of its cloud-powered AI Application […]
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Impact of CARE Act laws

Impact of CARE Act laws on Patient Outcomes

Policies designed to improve communication with patients and caregivers during hospitalization appear to be leading to better outcomes, researchers have found. Researchers with the University of Pennsylvania examined the impact of state laws that bring the caregiver into the process. The findings of the study were published May 1 in Jama Network Open. Since 2014, 42 states have […]
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cigna-updates-modifier-25-reimbursement-policy

Cigna Updates Modifier 25 Reimbursement Policy

Find out what you must do to get significant, separately identifiable E/M services paid. The Cigna Group recently updated its reimbursement policy for modifier 25. Effective May 25, if you are billing this health insurance company for an evaluation and management (E/M) service and a minor procedure, you may need to do more than append […]
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Patient Care Advancement

5 Medical Advances That Changes Patient Care’s Future

Every day, scientists strive to solve some of medicine’s toughest questions. Here’s a look at recent breakthroughs that tackle painful conditions and deadly diseases. Gene sequencing at record speeds to identify dangerous mutations. A treatment that delays Type 1 diabetes for years. A vaccine to prevent RSV infections, which kill thousands of Americans each year. […]
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Emerging Trends and Technologies For Healthcare Future

Future of Healthcare Technology: Emerging Trends and Technologies

The healthcare industry is on the brink of transformation, as a multitude of emerging technologies and trends, such as artificial intelligence, virtual reality, telehealth, and blockchain, are set to revolutionize it. The pace of innovation in healthcare technology is relentless and shows no signs of decelerating. A myriad of emerging technologies and trends, such as […]
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Updated HCPCS Coding Guidelines

Guide to the Latest HCPCS Level II Codes

A retroactive effective date of April 1 has been assigned to a newly introduced code. The Centers for Medicare & Medicaid Services (CMS) has released the results of its review cycle for drug and biological HCPCS Level II codes in the first quarter of 2023. Out of the 36 applications received, 23 have been approved […]
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5 Qualities of a Great Physician Billing Solution

Discover the Top 5 Qualities of a Great Physician Billing Solution

Ensure you make a well-informed choice when selecting a company to manage your reimbursements. Physicians seeking to improve their reimbursement rates, financial performance, operational efficiency, or focus on patient care should consider outsourcing their billing needs. However, choosing the right physician billing service for your practice can be a challenging task, as not all services […]
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