The ability to rapidly and accurately report such granular detail requires a robust data infrastructure. Instrumental to this infrastructure are the specific AMA Current Procedural Terminology (CPT®) product and administrative codes related to COVID-19 vaccines. Long described as the “common language of medicine,” the CPT code set is kept current through the work of the CPT Editorial […]
This has, in turn, put greater emphasis on the need for Revenue Cycle Management (RCM) systems to enable a healthcare provider to better manage transactions between payer, provider and patients. It can, through the use of various software platforms, boost revenues, reduce denials and enhance the patient experience. According to a survey published by health […]
In December 2021, the Centers for Medicare & Medicaid Services (CMS) released the proposed Notice of Benefit and Payment Parameters for 2023. This proposal kicks off the annual rulemaking cycle for the Marketplaces and the individual and group health insurance markets for plan year 2023 and beyond. This year’s notice is the first to […]
CMS has issued interpretative guidance on its healthcare worker vaccine mandate following the Supreme Court’s decision to allow the mandate to be enforced while some states challenge it in courts. The guidance released a day after the Supreme Court ruling states that facilities participating in Medicare and Medicaid in 24 states must ensure their employees […]
The complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with their own rules and requirements, creates administrative burdens and obstacles for providers. Ultimately, this complex system impacts the patient experience, as patients must […]
Small group coverage did not pursue the trends that many experts anticipated after the Affordable Care Act went into effect. From 2013 to 2020, small group coverage has maintained a fairly stable environment, researchers from the Urban Institute found. The researchers used the Medical Expenditure Panel Survey Insurance Component (MEPS-IC) in order to assess changes […]
AMA updated the CPT code for the third dose of Pfizer’s pediatric COVID-19 vaccine on the heels of the FDA’s recently expanded emergency use authorization. The American Medical Association (AMA) announced a Current Procedural Terminology (CPT) code set update to include a code for administering a third dose of Pfizer’s COVID-19 vaccine in children 5 […]
In one of the biggest attempts by the federal government to combat surprise medical billing, Congress in late 2020 passed the No Surprises Act (NSA), which imposes a host of new transparency and coverage requirements for employer-sponsored group health plans. Many of the most significant coverage changes were required to be implemented on Jan. […]
You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You provide excellent care for your patients and achieve great outcomes. […]
This is what providers can expect in 2022 in the form of new technology audits. During 2022, healthcare providers will see more options to exploit cyber technologies designed to aid them in management of Medicare audits. Below we review the informational challenges of managing an audit, and then turn to the types of cyber solutions […]