Category: Medical Billing

Policy-for-Rural-Emergency-Hospitals

CMS on establishing new policies for REH

It includes proposed enhanced payments for the additional costs of purchasing domestically made NIOSH-approved surgical N95 respirators. The Centers for Medicare and Medicaid Services is proposing actions meant to advance health equity and improve access to care in rural communities by establishing policies for Rural Emergency Hospitals (REH) and providing for payment for certain behavioral […]
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New Rule on Medicare Physician Fee Schedule for the CY 2023

In addition to physician reimbursement cuts, CMS included changes to the Quality Payment Program in the CY 2023 Medicare Physician Fee Schedule proposed rule. In its recently released calendar year (CY) 2023 Medicare Physician Fee Schedule (PFS) proposed rule, CMS proposed Quality Payment Program (QPP) changes to the Merit-based Incentive Payment System (MIPS) and Advanced […]
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The Major Strategies to Improve the Patient Collections

Open communication, payment options, and understanding are all key to improving patient collections in a consumer-oriented healthcare landscape. The rising cost of healthcare in the United States has left consumers feeling lost and overwhelmed. High deductible healthcare plans, co-pays, and out-of-pocket medical expenses have all contributed the emergence of healthcare consumerism, which is the pursuit […]
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Surprise Medical Bills for nearly 20% of Adults

Twenty percent of adults said they or a family member has received a surprise medical bill since the No Surprises Act went into effect on Jan. 1 according to a Morning Consultant report released July 7. Morning Consultant conducted a survey among a representative sample of 2,210 U.S. adults between June 22-24, according to the […]
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Claim Denial Rates as High as 80% for In-Network Services

A new analysis shows that claim denial rates for in-network services among Healthcare.gov marketplace payers varied significantly, with some as high as 80%. Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family Foundation. Marketplace payers must […]
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Nuances-of-Billing-Cataract-Surgery-Image

Keep an eye on Ophthalmology Billing

Learn the nuances of billing these ophthalmology services and reduce your compliance risk. When I first started working in ophthalmology, I worried I would become bored: I mean, after all, it’s just two little eyes, right? I quickly learned how complicated ophthalmology can be and that there are many nuances and layers to coding and […]
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Medicare-Physician-Payments-picture

Where did all the Medicare Physician Payments Go

The federal government probably won’t be raising Medicare reimbursements next year, and physician organizations are strongly objecting. At its Jan. 13 meeting, the Medicare Payment Advisory Commission (MedPAC), which advises Congress on financial issues pertaining to Medicare, recommended against increasing base payment rates to doctors in 2023. It justified its decision in part by noting […]
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Can you bill E/M from the same appointment?

Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment. Motivated by a desire to avoid audits, many physicians tend to undercode for the work they perform. Others, however, are just unaware that the idea that […]
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Updates on End-Stage Renal Disease Prospective Payment copy

Updates on End-Stage Renal Disease Prospective Payment

CMS issued a proposed rule to update payment rates and policies under the End-Stage Renal Disease Prospective Payment System for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2023. Here are four takeaways from the proposed rule: Under the proposed rule, Medicare expects to pay $8.2 billion to approximately 7,800 facilities […]
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