Category: Blog

health-equity-and-sdoh-a-payer-perspective-update

Health Equity and SDOH: A Payer Perspective / Update

As part of its ongoing mission to improve the health of America, the Blue Cross Blue Shield Association (BCBSA) announced its National Health Equity Strategy in April 2021 to confront the nation’s crisis in racial health disparities. This strategy is intended to change the trajectory of health disparities and reimagine a more equitable health care […]
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Medical organizations continue to fight surprise-billing dispute process: 5 details

A coalition of medical organizations, including the Physicians Advocacy Institute and 16 state medical associations, filed an amicus brief supporting a legal challenge to the No Surprises Act dispute resolution process, according to a news release emailed to Becker’s. Five things to know: The groups are supporting a lawsuit filed by the American Hospital Association […]
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CMS releases Medicare Advantage, Part D proposed rule: 7 changes to know

CMS is proposing a new rule that aims to cut prescription drug costs, increase contract vetting and improve health equity, according to a Jan. 6 news release. The proposed changes primarily target Medicare Advantage and Part D plans. CMS also noted that the proposed changes come with “modest costs” that should not affect bidding, premiums […]
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Study examines differences in coverage denials for traditional Medicare, MA

Traditional Medicare coverage rules make up the bulk of denied services and spending compared to a Medicare Advantage plan, according to a new study in the latest Health Affairs issue. The study, led by the University of Pennsylvania, Harvard University and CVS Health, relied on Medicare Advantage claims that were denied for beneficiaries enrolled with […]
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Many States Hit Hard by COVID-19 Limit Telehealth Practice, Report Finds

States like New York, California, and Washington have laws that block interstate telehealth, while only three states allow all providers to easily practice telehealth across state lines. Though telehealth use reached new heights during the COVID-19 pandemic, a new report shows that some of the states that were hit the hardest by the novel coronavirus […]
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When To Report an Incidental Finding

DOJ lawsuits may be your road map to risk adjustment compliance. The growing prevalence of risk adjustment in healthcare has forged new processes in documentation practices that have resulted in many organizations adopting practices that bend the cast iron rules for ICD-10-CM coding. We are starting to see some of the long-term dangers of ambitiously […]
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Understand Critical Care Before You Code

A solid understanding of guidelines and COVID-19-related complexities will limit claim denials and audits. Deciphering documentation to determine what qualifies as critical care services can be challenging for medical coders and auditors. With limited critical care codes available for assignment, reporting may appear relatively straightforward at first glance. However, there are many considerations that coders […]
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Get Caught Up on Coding and Billing News

New COVID-19 vaccine status codes, changes and corrections to the 2022 CPT code set, Medicare Physician Fee Schedule (MPFS) payment changes, and prior authorization code list changes — that’s what’s on the agenda this month. Read all about it! 3 New Codes Improve COVID-19 Vaccination Status An April 1, 2022, update to the 2022 ICD-10-CM […]
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