Category: Blog

Inflation Reduction Act

Medicare Prescription Drug Benefit Premiums Spike Amid Inflation Reduction Act Changes

Inflation Reduction Act: A Double-Edged Sword for Medicare Beneficiaries: The Biden administration’s recent announcement of the first Medicare drug price cuts, mandated by the 2022 Inflation Reduction Act, has dominated headlines. However, another significant impact of this law—substantial premium hikes for some Medicare beneficiaries—has largely been overlooked. The Inflation Reduction Act represents the most sweeping […]
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CDI and coding

Overcoming CDI and Coding Challenges: The Power of AI-Driven Solutions

Defining the Challenge: Overcoming Obstacles in CDI and Coding: To clarify the overwhelming claims made by technology vendors, I’ve provided some basic definitions. As we embark on this journey, it’s crucial to pinpoint the specific obstacles we face. This will help us demonstrate to senior leadership and stakeholders the need for AI-driven solutions to enhance […]
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MA Prior Authorization Denials

Medicare Advantage Prior Authorization Denials on the Rise

Surge in MA Prior Authorization Denials: New Study Reveals A new study highlights significant variation among Medicare Advantage plans regarding the number of determinations made and the frequency of denials. Notably, MA Prior Authorization Denials surged between 2021 and 2022, according to a recent analysis from health policy research. Researchers examined data from the Centers […]
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Value-Based Care challenges

Value-Based Care: Navigating Challenges and Opportunities in Revenue Cycle Management

RCM and Value-Based Care Challenges and Opportunities: Healthcare is a dynamic field constantly evolving to improve patient and staff experiences. As the industry transforms, it’s crucial to understand both the potential benefits and drawbacks of these changes. One area experiencing significant evolution is Revenue Cycle Management (RCM). The shift towards value-based care models is a […]
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Reimbursement-methodology

Understanding Medical Codes and Reimbursement Methodologies

The Role of Medical Codes in Reimbursement Methodologies: Medical codes, such as CPT, HCPCS, and ICD-10 (CM and PCS), are essential components of various reimbursement methodologies. The Inpatient Prospective Payment System (IPPS), used by Medicare fee-for-service, categorizes patient stays into Medicare Severity Diagnosis Related Groups (MS-DRGs) based on ICD-10 codes processed through a computerized system. […]
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Coverage Denials

Survey Reveals Key Issues with Challenging Surprise Medical Bills and Coverage Denials

A new study by the health care system reveals a significant gap in consumer healthcare rights. Despite attempts to curb surprise medical bills, a large portion of insured Americans are still receiving unexpected charges. Adding to this problem is the high rate of coverage denials, leaving patients with substantial out-of-pocket costs and causing financial hardship […]
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impact urology practices

Medicare Physician Fee Schedule 2025: Urology Practice Impact

urology practices: The Centers for Medicare & Medicaid Services (CMS) unveiled its proposed Medicare Physician Fee Schedule for 2025 on July 10, 2024. This outlines potential payment adjustments and policy changes that would take effect starting January 1, 2025. A public comment period will follow, during which CMS will gather feedback to inform the final […]
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Generative AI

GenAI Revolutionizing Healthcare: Transforming Revenue Cycle Management

Generative AI is revolutionizing healthcare: Recent breakthroughs have seen these models excel in medical exams, complex diagnoses, and even pandemic response strategies. Advanced language models like GPT-4, Google’s Bard, and specialized healthcare models are now capable of handling intricate tasks that can dramatically improve clinical decision-making and administrative efficiency. The immense potential of Generative AI […]
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Medicare payment rules 2025

CMS Unveils Proposed Rules Impacting Medicare Payments for 2025

The Centers for Medicare & Medicaid Services (CMS) has unveiled a series of Medicare payment rules that will dramatically impact Medicare payments for 2025. These changes encompass payment rates, coding guidelines, coverage criteria, and quality measures for various healthcare providers. Physicians, in particular, face a proposed average payment rate cut of 2.93% under the fee […]
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medical billing audit services

Optimize Billing Practices with Medical Billing Audits

A domestic medical billing audit is an operation that inspects and estimates the value and dependability of clinical documentation and the overall medical billing process. This technique closely examines health records upheld by the practice and evaluates medical billing data presented to the payers to make sure that the practice picks out, observes, and rectifies […]
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