Category: Medical Billing

Denial Management Services

Developing A Hospital Claim Validation Strategy To Prevent Denials

A comprehensive hospital claim validation strategy that prevents denials and improves efficiencies hinges on the right blend of retrospective and pre-bill reviews. The time to strengthen hospital compliance programs through claim validation is now. According to healthcare finance and information management leaders surveyed by HIMSS Media, clinical documentation and coding were the revenue cycle processes most vulnerable […]
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Value-Based Care Models

Verma Presses Hospitals to Assume Risk in Value-Based Care Models

Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
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CAR T-cell therapy

Coding CAR T: Cancer Treatment Revolutionized

Now that revolutionary cancer therapy, Chimeric Antigen Receptor T-cell (CAR T-cell), is covered, let’s take a look coding CAR T. Last month the Centers for Medicare & Medicaid Services (CMS) finalized the long-sought rules for coverage of CAR-T, novel cutting-edge, often curative treatments that utilize the patients’ own genetically modified immune cells to fight cancer. The […]
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The Rx For Improved Patient Billing Experiences

Helping patients understand their financial responsibility and pay for services continues to be driven by an outdated and unnecessarily complex experience. Last year, three in 10 Americans had an unpaid healthcare bill go to collections. As more of the financial burden falls to patients with rising costs and an increase in high-deductible health plans, consumers are frustrated […]
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Medicare billing privileges

CMS Pitches Sweeping Changes To Rules For Maintaining Medicare Billing Privileges

CMS’ proposed 2020 Medicare Physician Fee Schedule includes substantial changes to the rules for obtaining and maintaining Medicare billing privileges. A one-paragraph statement in the proposed rule calls for applying Medicare enrollment approval and revocation rules for opioid treatment programs to all physicians and other eligible professionals. The proposal would allow CMS to revoke Medicare […]
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Billing and coding errors

Identifying & Addressing Common Medical Billing Errors Pre- & Post-Payment

It is estimated that as high as 80 percent of medical bills contain errors.1 As healthcare costs continue to rise, so too is the need for healthcare payers to reduce overspending resulting from avoidable billing errors and improper claims reimbursement. Given the sheer volume of claims submitted each day, capturing and reconciling discrepancies based off of […]
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MIPS-Payment Models

CMS Unveils New MIPS ‘Framework’ Aimed at Reducing Reporting Burden

The Trump administration has proposed updates to the Merit-based Incentive Payment System (MIPS) it says would ease the quality reporting burdens in the program. The Centers for Medicare & Medicaid Services (CMS) introduced a new framework for MIPS called MIPS Value Pathways (MVPs) with the goal of making it easier for physicians to participate in the program. Under […]
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Union Lowers Medical Bills With Direct Negotiations

As companies shift more and more healthcare costs to their employees, the doormen, office cleaners, cafeteria staff and other members of the union 32BJ SEIU remain among the lucky few who pay no premiums and have no deductibles as part of their benefit plan. Keeping it that way has been no easy task. With each new collective-bargaining agreement, the […]
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