Category: Blog

High-Cost-Connection-to-Support-Better-Health-Equity

Breaking the High Tech/High Cost Connection to Support Better Health Equity

Healthcare costs continue to rise in this country. Healthcare spending totaled $3.8 trillion in 2019, $11,582 per person. In 2028, it projects that spending will rise to $6.2 trillion, or $18,000 per person. These increases are happening at the same time the COVID-19 pandemic revealed systemic inequities in health equity, and how difficult it is […]
Learn More
Organizations Settle False Claims Act Violations

CA Healthcare Organizations Settle False Claims Act Violations

The False Claims Act settlements alleged that the healthcare organizations knowingly submitted improper Medicaid claims for services provided to California’s Medicaid expansion population. A California county organized health system and three healthcare providers have reached a $70.7 million settlement to resolve allegations that they violated the False Claims Act by submitting fraudulent claims to California’s […]
Learn More
New Coding Issues to Confront Coders

New Coding Issues Emerge To Confront Coders

  The new codes and subsequent issues will be effective Oct. 1, 2023. According to senior healthcare consultant Laurie Johnson, who presented the information during the series, three major issues emerged from her research and manifested themselves in her presentation —a presentation that was augmented with commentary from Erica Remer, MD, co-host for the long-running […]
Learn More
Final Surprise Billing Rules QPA

Biden Administration Releases Final Surprise Billing Rules

The final surprise billing rules downgrade the weight the QPA has on out-of-network payment determinations and establishes documentation requirements for down coding situations. The Biden Administration has released final surprise billing rules implementing the No Surprises Act, a federal law enacted in January 2021 that protects patients from out-of-network medical bills when they seek care […]
Learn More
Prior-authorizations-and-MedPAC-recommendations

Prior Authorizations and MedPAC Recommendations: MGMA’s view

Prior authorizations and Medicare reimbursements are some of the most consistently cited sources of issues at primary care practices. Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), joined us in April to discuss his organization’s lobbying efforts. The following interview has been edited for length and clarity. Medical […]
Learn More
Value-based-revenue-on-primary-care-income

Value-Based Revenue Makes up 6.74% of Primary Care Income

MGMA report shows value-based contracts account for $30,922 per provider The Medical Group Management Association released a report looking at the proliferation of value-based contracts and how quality metrics tie-in to revenue. The report, 2022 MGMA DataDive Practice Operations, shows that revenue from value-based contracts accounted for varying amounts of total medical revenue in 2021 […]
Learn More
Locum-Tenens-Physicians-to-fill-vacant-positions

Locum Tenens Physicians To Fill Vacant Positions

  Hospitals are increasingly utilizing locum tenens physicians, advanced practice providers (APPs), and telehealth services to address staffing shortages. The Innovation & Flexibility: Journey to Sustainable Healthcare Report reflects data from 129 healthcare administrators representing a range of facility types and sizes. The COVID-19 pandemic exacerbated hospital staffing shortages as many clinicians faced burnout and […]
Learn More
Cancer Centers Fail to Comply with Hospital Price Transparency Rule

Cancer Centers Fail to Comply with Hospital Price Transparency Rule

Failing to post files in a machine-readable format was the most common violation of the hospital price transparency rule among NCI-designated cancer centers. Less than one-third of hospitals with National Cancer Institute (NCI) cancer center designation were fully compliant with the CMS hospital price transparency rule, according to research published in JAMA Surgery. The price […]
Learn More
x