Category: Medical Billing

No-Surprises-Act-Compliance-as-a-New-Burden

No Surprises Act Compliance Debuted as a New Burden

Regulatory burden is on the rise yet again as practices struggle with prior authorizations, No Surprises Act compliance, and the Quality Payment Program, MGMA reports. Prior authorizations are still the top regulatory burden according to executives from group practices, while No Surprises Act compliance has debuted on the list this year as the second most […]
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Medicare-Overpayments-to-Hospitals

CMS System Edits Reduced Medicare Overpayments to Hospitals

Medicare overpayments totaled $39.3 million between September 2016 and December 2021, but most of those improper payments occurred before CMS corrected its system edits error in May 2019. CMS system edits helped reduce Medicare overpayments to acute care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, a report from the […]
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Potential-Medicare-Payment-Cuts-for-2023

The potential Medicare payment cuts for 2023

The potential Medicare payment cuts for 2023 reflect the proposed 4.5 percent decrease in the Medicare conversion factor and the 4 percent PAYGO sequester. As medical groups expect to see Medicare payment cuts in 2023, practices are considering limiting the number of new Medicare patients and reducing clinical staff to ensure financial stability, according to […]
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State Surprise Billing Laws for Out of Network Payment | Case Studies | AllZone Management Services Inc.

State Surprise Billing Laws Impact Out-of-Network Provider Charges

Provider charges for out-of-network care increased by $1,157 after the passage of state surprise billing laws that allow arbitrators to consider provider charges in a surprise billing dispute. State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges […]
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New EM Billing Guidelines for unreimbursed Services | Case Studies | AllZone Management Services Inc.

New E/M Billing Guidelines for Unreimbursed Services

Recent changes to evaluation and management (E/M) billing guidelines that allow physicians to bill for previously unreimbursed services are producing higher revenues for longer patient visits, according to results of a new study. The study in JAMA Network Open looks at the financial impact of CMS’s 2021 expansion of its time-based billing guidelines to include […]
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Value-Based-Payment-Revenue-at-Primary-Care

Value-Based Payment makes up 6.7% of Primary Care Revenue

Value-based payment is severely lacking as a percentage of total medical revenue across practices as providers face scheduling and billing challenges. The transition to value-based payment is moving at a snail’s pace despite healthcare’s long journey with the transition away from fee-for-service, new survey data indicates. Value-based payment made up just 6.74 percent of total […]
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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 […]
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