Category: Medical Billing

Billing and Coding for Coronavirus_ 7 things to know

Billing and Coding for Coronavirus: 7 things to know

CMS has released several fact sheets in recent weeks on billing and coding to provide guidance to healthcare organizations testing and treating patients for COVID-19, the disease caused by the novel coronavirus. Seven things to know: CMS developed Healthcare Common Procedure Coding System code U0001 to allow laboratories and healthcare providers to bill for using the CDC’s […]
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New Healthcare Price Transparency Rule

New Healthcare Price Transparency Rule – The Best, Worst, and Most Realistic Case Scenarios

The American Hospital Association has filed a lawsuit to block the rule. On Nov. 15, 2019, the Trump Administration proposed a new healthcare price transparency rule that would basically require hospitals to explain how much a medical service would cost before a patient receives treatment. This rule is due to become effective in January 2021. The […]
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MIPS Changes

What You Need to Know About 2020 MIPS Changes

In November 2019, CMS published the 2020 Quality Payment Program Final Rule (the “2020 MIPS Final Rule Changes”). Below is a summary of some of the most notable changes to the Merit-Based Incentive Payment Program (MIPS). For a complete list of changes, please review the 2020 MIPS Final Rule or CMS’ Quality Payment Program Resource […]
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Non-Physician Provider Use of E&M Codes

Non-Physician Provider Use of E&M Codes

Q: There seems to be a trend of practices using a variety of staff as ‘educators’ to provide patient education. The more recent ‘twist’ is the billing of E&M codes for non-physician providers, based in either clinical documentation or time-based, under the ‘incident to” provision – even though the physician does not see the patient for these […]
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Providers to Focus on Patient Billing

Providers to Focus on Patient Billing, Policy Heading into 2020

In addition to patient billing and policy, healthcare M&A and workforce diversity will also be major trends going into the new year, according to PwC’s Health Research Institute. Patient billing, policy and regulation, healthcare mergers and acquisitions, and workforce diversity will be some of the top priorities for provider organizations in 2020, predicted researchers at PwC’s Health […]
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AI Can Help Health Plans Become Member-Centric

How AI Can Help Health Plans Become Member-Centric

Improving the customer experience is no longer an idea that’s relegated to the retail or hospitality industries. Now, the idea has gained traction across many industries, including healthcare. For health plans, improving the customer experience and providing member-centric care helps drive member acquisition and retention and improve reimbursement (via a better STARS rating). With so […]
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J Code Activations Simplify Billing Reimbursements For Practices

J Code Activations Simplify Billing Reimbursements For Practices

Several CMS-designated permanent and product-specific J-codes recently went into effect, allowing three ophthalmology-minded pharmaceutical companies to expand reimbursement through commercial and Medicare insurance plans. J-codes were activated Oct. 1 for FDA-approved products manufactured by EyePoint Pharmaceuticals, Ocular Therapeutix and Omeros. In the past, J-codes were announced once a year; now, CMS is issuing certain J-codes […]
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