During the Coronavirus pandemic, the Centers for Medicare and Medicaid Services (CMS) has taken unprecedented action to expand telehealth for Medicare beneficiaries. Since people were advised to stay at home to reduce risk of exposure of COVID-19, there was an urgency to increase access to telehealth services to help people who need routine care and […]
Every year, the Trends in Healthcare Payments Annual Report is distributed to start a conversation about the current state of the industry and shine a light on areas where change is needed. For healthcare providers, the report has consistently found that more of their revenue is dependent on out-of-pocket payments from consumers and less is covered […]
Over the past couple of months, the COVID-19 crisis has disrupted the traditional delivery of care. Some patients are avoiding clinical settings out of fear of catching the virus. But now that regions are starting to re-open, people are looking for guidance and comfort to re-engage. Provider organizations need to be proactive and drive revenue […]
CMS is now offering MIPS credit for all participating clinicians of the Quality Payment Program to help report and provide COVID-19 data. The Centers for Medicare & Medicaid Services (CMS) is asking all clinicians in the Quality Payment Program (QPP) to contribute to the scientific research and reporting efforts to help curb the spread […]
Denials, automation, and surprise billing are perennially tricky & common revenue cycle issues, but new twists on those topics add an extra layer of complexity. When it comes to revenue cycle management, a handful of common revenue cycle issues are nearly always a struggle, year after year. For instance, denials, automation, and surprise billing are […]
COVID-19 is creating unique healthcare revenue cycle challenges around billing and coding, patient financial responsibility, and resource allocation. As entire nations encourage their populations to stay inside to avoid COVID-19, healthcare providers are more active than ever in response to the outbreak of the novel coronavirus. This activity is having a significant impact on the […]
CMS is proposing changes and a three year extension to the Comprehensive Care for Joint Replacement Model (CJR), which provides a flat set of payments to hospitals for an episode of care through 90 days past patient discharge. The program was due to expire at the end of this year. The agency also wants to include outpatient […]
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage plan (MA, or Part C) and the Medicare prescription drug benefit (Part D) program. In years past, CMS has also issued a “call letter,” not subject to the regulatory process, to provide additional information for plans to use […]
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 […]
With an election year just about upon us, there are a number of changes coming from the current administration that are going to impact healthcare in 2020. Changes in allowable benefits, home health, hospice carve-ins, and new CPT codes for remote home monitoring are just a sample of these. There are an additional set of fundamental […]









