As a result of their hospital stays that exceeded three days – all of which were outpatient Part B stays – a group of Medicare beneficiaries filed a class action lawsuit in 2010 to recover their costs from stays in skilled nursing facilities (SNFs) for rehabilitation following an illness. It was probably the height of […]
To capture Medicare reimbursement for complex Medicare patient visits, you must know when to use this G2211 Code add-on code. To report the additional time, effort, and related practice expenses associated with caring for Medicare patients across the continuum of care, qualified healthcare providers can begin billing HCPCS Level II codes on Jan. 1, 2024. […]
On July 13, Medicare released its Proposed Rule, which outlined changes to different Medicare programmes including as quality programmes, MIPS, rural employment, telemedicine, and others. This comprehensive yearly document of 2,033 pages covers the planned programme adjustments for fiscal year 2024. Between the release of the Draft Rule and the publishing of the Final Rule […]
The healthcare landscape is undergoing an unprecedented evolution, set to drive a significant transformation in patient experience in 2024. Recent technological advancements, coupled with increased patient expectations for enhanced care, are converging with a comprehensive approach encompassing clinical, social, and behavioral facets of patient well-being. This convergence necessitates the modernization of care delivery systems to […]
This year, the CMS has frequently halted and resumed arbitration due to court cases causing disruptions in the regulatory process aimed at settling surprise billing disputes. Summary Overview: Last Friday, the CMS finalized its revamp of the No Surprises Act resolution process, fully reopening the portal for resolving disputes, including batched and single disputes for […]
Hospital bills that remain unpaid for over 90 days often stem from claims that were initially rejected by payers. Additionally, the longer a bill is initially declined, the greater the likelihood that it will take more than 90 days to be resolved. These discoveries are highlighted in a recent report by Healthcare Consulting Company, which […]
The inception of Recovery Audit Contractor (RAC) audits dates back to 2005, reaching their zenith around 2010 before encountering a deceleration amidst the COVID-19 period. In 2006, Congress granted the Centers for Medicare & Medicaid Services (CMS) the authority to launch the Recovery Audit Contractor program across three initial states: New York, Florida, and California. […]
Roughly 65% of rejected claims aren’t reprocessed for resubmission (Zindl, 2021). As one of the healthcare industry’s numerous challenges, the upward trend of denied claims persists, with many left unaddressed. This has repercussions for both providers and patients alike. When denied claims remain unsubmitted, providers face substantial losses. Beyond revenue, these rejections strain staffing resources. […]
The Senate Finance Committee proposed that the full chamber should review a legislation that could instigate alterations in physician practices. This proposition was discussed during a 90-minute meeting on November 8, 2023, regarding the bill named “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” This bill encompasses diverse aspects of healthcare, including mental […]
While not every policy alteration by the Centers for Medicare & Medicaid Services (CMS) grabs headlines, it’s often these less-publicized changes that lead to the most billing complications. Here are a couple of recent adjustments made by CMS that you might have overlooked. New Place of Service Code CMS introduced a new Place of Service […]