Category: Medical Billing

Auditing facility services using a three-pronged approach

Auditing Facility Services: Changes to evaluation and management (E/M) services in 2021 and 2023 have excited and confused auditors. I am glad that the seemingly trivial criteria required for the level of service (history, testing) are an advantage to confusion when implementing new medical decisions (MDM)  in a balanced environment. In early 2021, AAPC Services […]
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Prior Authorization Transformation

How Prior Authorization Transformation Benefits Patients, Providers and  Payers

Prior authorization transformation of consent is a source of worry and concern for everyone involved: patients, members, providers, and payers. What was needed was a structure to coordinate all stakeholders and organize the program. In January 2024, the Centers for Medicare and Medicaid Services (CMS) finalized requirements to expedite the authorization process; this requirement will […]
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Survey: High Initial Claim Denials Impact Healthcare Providers

The Rising Denial Rates in Healthcare Claims Processing Initial Claim Denials: In a new survey conducted by healthcare Company an increased percentage of initial claims are denied by private payers, including pre-approvals for medical claims. Hospitals, health systems, and post-acute care providers may have a difficult time getting paid for medical services. The survey respondents […]
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Medicare Conversion Factor

Medicare Conversion Factor Increases, But Payments Remain Lower

Medicare Conversion factor are up but payouts are still down compared to last year. Healthcare professionals will see a slight upward adjustment to their Medicare payments starting March 9 after President Biden signs the Consolidated Appropriations Act (CAA), 2024.  Really fortunately, although the 2024 CAA increases the conversion factor (CF) finalized for calendar year (CY) […]
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Remote Patient Monitoring

Remote patient monitoring: pros and cons

Remote Patient Monitoring: health care providers reached the same conclusion for themselves and their patients. They found that this technology delivers improvements in the form of better patient outcomes, reduced costs, and the ability to deliver more personalized, patient-centered care at the same time. Reduce workload. Fortunately, the entire healthcare industry is also enjoying these […]
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Streamlining Prior Authorization Final Rule

The Impact of CMS-0057-F on Streamlining Prior Authorization Processes

An improved Prior Authorization Final Rule can result in shorter wait times, fewer delays in the delivery of patient care, and a reduction in costs. CMS has finalized the Interoperability and Prior Authorization Final Rule (CMS-0057-F), which was published by CMS on January 17, 2024. It will reduce the burden on patients, providers, and payers […]
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IDR resolution processing fees have been revamped

Updated IDR Processing Fees Post-No Surprises Act Lawsuit

As a result of the most recent provider lawsuit, IDR processing fees have been reworked. Since its inception on Jan. 1, 2022, the No Surprises Act (NSA) has had its growing pains, including four lawsuits challenging the process of Independent Dispute Resolution (IDR). Out-of-network services are paid for with this process when health plans, healthcare […]
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