The number of prior authorization requests continues to increase — despite promises to the contrary by payers — costing physicians time and money. A Medical Group Management Association (MGMA) poll found that 70% of medical groups indicated that prior authorizations increased in the last year. Physicians say that their practices continue to struggle with either […]
The proposed rule seeks to reduce administrative burdens and address delays in patient care. The Centers for Medicare & Medicaid Services (CMS) announced a proposed rule on Dec. 6, 2022, aimed at improving the prior authorization process and interoperability between providers, payers, and patients. The Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P) […]
Providing care management services, including chronic care management (CCM) and principal care management (PCM), is not easy. The first overarching challenge is that not enough patients actually participate in care management with a primary care physician. In fact, A recent report from the Primary Care Collaborative and the American Academy of Family Physicians’ more Americans […]
The billing and collection process in medical offices can be a time-consuming and error-prone process. This can lead to denied claims, uncollected revenue, and frustrated patients. Medical billing companies are looking for ways to optimize this process to improve efficiency, accuracy, and patient satisfaction. One way to optimize the billing and collection process is to […]
E/M, Gastro, and Lab Coders, take note. The American Medical Association (AMA) announced some last-minute corrections to the CPT® code set effective Jan. 1, 2023. Add these to your code book, along with the previously released corrections, to ensure you start the year off right with accurate codes and guidelines. Evaluation and Management (E/M) In […]
Quality metric reporting can be a significant challenge to health care administration due to a number of obstacles. First and foremost, you need buy-in from the physicians providing the care to the patients. Without this, it is difficult to make any meaningful changes to the pattern of care provided. Second, it requires having a very […]
Health care leaders are anticipating a turbulent 2023, according to a report. Staffing, inflation, shrinking margins, and supply chain issues are among the top concerns that will continue to challenge hospitals and health systems and have an outsized effect on overall strategy. Here are the four factors identified as being the most likely to impact […]
The American Hospital Association (AHA) and Better Medicare Alliance (BMA) both support the agency’s effort to improve Medicare Advantage (MA). In an attempt to reform MA, CMS released a proposed rule that aims to streamline prior authorization, promote health equity, and curb deceptive marketing. The Biden administration has shown a commitment to increasing oversight of […]
With the hustle and bustle of the holiday season, it is very easy to get distracted with accidents due to extra activities and overlook everyday actions that help us to be safe and happy. Accidents during such holiday season will make physician, emergence care and urgency care little busy. Treatments can be reimbursed with medical […]
Here are four must-know key performance indicators that providers should know and use when looking to improve outcomes and the patient experience. Key performance indicators (KPIs) have always mattered, but they are now more relevant than ever in the healthcare industry, as providers make the shift to value-based care. While there are many common types […]