Category: Revenue Cycle Management

cms-vaccination-mandate-rule-blocked

The CMS Vaccination Mandate Rule Blocked

If you’re leaning toward pausing your vaccination requirement process, be ready to crank it back up on a dime, legal experts stress. After the Biden administration issued two COVID-19 vaccination regulations on Nov. 5 — one from the Centers for Medicare & Medicaid Services and one from the Occupational Safety and Health Administration — states […]
ms-medicaid-expansion-could-reduce-state-medicaid-spending

The Mississippi’s Medicaid Expansion Could Reduce State Medicaid Spending

  Mississippi’s Medicaid program ranks poorly for its access to and quality of care, but Medicaid expansion could increase healthcare coverage along with lowering state Medicaid spending. Mississippi could achieve lower state Medicaid spending over the course of five years by expanding its Medicaid program with the American Rescue Plan boost to federal matching, a […]
hhs-telehealth-use-medicare-increased-63-fold-last-year-behavioral-health-increasing-most

Telehealth use in Medicare increased 63-fold last year with behavioural health increasing the most

The number of beneficiaries in traditional Medicare using telehealth exploded 63-fold in 2020 from 840,000 in 2019 to nearly 52.7 million, a new study found. The study, released Friday (PDF) by the Department of Health and Human Services (HHS), comes as advocates are pressing to make key flexibilities the federal government enabled at the start […]
medicare-advantage-plans-and-the-two-midnight-rule

Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage plans hold up their end of the contract with CMS, and provide, at a minimum, a fair reimbursement for services delivered. The physician advisor is a fast-growing specialty that has evolved into so much more than someone who performs endless chart reviews for observation status determinations, medical necessity reviews, peer-to-peer conversations with payors, […]
a-snapshot-of-telehealth-payment-policies-across-states

A Snapshot of Telehealth Payment Policies Across States

Telehealth policies vary from state to state but in the past few months there have been some common regulation changes across the country. Specifically, states modified their Medicaid reimbursement policies for telehealth services, the Center for Connected Health Policy’s (CCHP) State Telehealth Laws and Reimbursement Policies Fall 2021 report revealed. CCHP gathered data from state […]
newly-expanded-supplemental-benefits-medicare-advantage-grew-43-2022

Newly expanded supplemental benefits in Medicare Advantage grew 43% for 2022

Along with that growth, the number of plans offering more than one benefit increased 15%, from 175 to 202. The findings show that under the Centers for Medicare and Medicaid Services’ reinterpretation of “primarily health-related” benefits, supplemental benefit offerings in Medicare Advantage – such as home-based palliative care, in-home support services, caregiver support and therapeutic […]
steps-you-can-take-to-defend-against-exclusion-of-zero-paid-claims

The Steps You Can Take to Defend Against Exclusion of Zero-Paid Claims

Zero-paid claims are defined as any claims submitted by healthcare providers that are not paid. The problem is that when performing statistical extrapolations, auditors (ZPICs, or Zone Program Integrity Contractors, and others) routinely screen out zero-paid items when they extract the claims from a sample. This is a violation of at least 12 parts of […]