Category: Revenue Cycle Management

2023-Medicare-Physician-Fee-Schedule

2023 Medicare Physician Fee Schedule on Unsustainable Cuts

Lower Medicare payments to physicians will lead to patient care by reducing access to services, according to medical groups commenting on the 2023 Medicare Physician Fee Schedule (PFS). In July, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the 2023 proposed rule and physician groups have been responding, including with detailed comments published […]
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Physician-Practice-Costs-Grew-20

Physician Practice Costs Grew 20% Per Claim

Following a private equity acquisition, physician practices saw a 20.2 percent increase in charges per claim, an 11 percent raise in the allowed amount per claim, and a 37.9 percent increase in new patient visits. Private equity acquisition of physician practices in dermatology, gastroenterology, and ophthalmology was associated with increased healthcare spending and utilization, according […]
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No-Surprises-Act-More-to-Come

More Versions to Come: No Surprises Act

Although the Biden Administration claims this is the final regulation, there is evidence more is yet to come. The Biden administration released the final No Surprises Act regulation recently but advised healthcare professionals that this final version is not the final one and promised more to come. The latest final rule was narrowly focused on […]
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Prior Authorization Reform in Medicare Advantage | Case Studies | AllZone Management Services Inc.

Prior Authorization Reform in Medicare Advantage

Prior Authorization reform in Medicare Advantage would help relieve administrative burden for medical groups and reduce patient care delays, MGMA said. The Medical Group Management Association (MGMA) has urged CMS to implement policies that support prior authorization reform and value-based care contracts within the Medicare Advantage program. MGMA submitted comments to CMS Administrator in response […]
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Home Health Medicare Reimbursement

Recent Updates on Home Health Medicare Reimbursement

AHA said that the 2.7 percent Medicare reimbursement update for home health agencies does not accurately reflect the financial challenges that home health agencies have faced during the pandemic. The American Hospital Association (AHA) has urged CMS to reconsider the Medicare reimbursement update for home health agencies proposed in the Calendar Year 2023 Home Health […]
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High-Cost-Connection-to-Support-Better-Health-Equity

Breaking the High Tech/High Cost Connection to Support Better Health Equity

Healthcare costs continue to rise in this country. Healthcare spending totaled $3.8 trillion in 2019, $11,582 per person. In 2028, it projects that spending will rise to $6.2 trillion, or $18,000 per person. These increases are happening at the same time the COVID-19 pandemic revealed systemic inequities in health equity, and how difficult it is […]
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Physician-Fee-Schedule-Proposed-Rule-2023

Newly Revised CPT E&M Guidelines: Physician Fee Schedule Proposed Rule

A major revision of the Current Procedural Terminology (CPT) Evaluation and Management (E&M) Guidelines for Office and Outpatient Visits (O/O Visits), Split/Shared Visits, and Critical Care Time billing was implemented Jan. 1, 2021. You would think that all office-based providers would have been made aware of this and changed their documentation accordingly, but there is […]
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Provider Profit Margin-Post-Covid

Provider Profit Margins to Grow After COVID-19

Provider profit margins might increase after the COVID-19 pandemic based on three key shifts in payer mix and care delivery. Healthcare providers faced a rough couple of years as the COVID-19 pandemic dampened financial growth, but the post-pandemic future should create a favorable environment for provider profit margins, according to a new report. The report […]
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