Category: Revenue Cycle Management

Medicare rate for COVID-19 vaccinations

MA Reimburses 2X Medicare Rate for Some COVID-19 Vaccinations

Healthcare providers in Massachusetts are getting twice the standard Medicare rate for COVID-19 vaccinations in an effort to accelerate vaccine rollout, according to a recent provider bulletin from the state’s Medicaid office. The provider bulletin released in January 2020 states that providers administering the two-dose vaccines from Pfizer and Cambridge, Massachusetts-based Moderna will receive $33.88 for the […]
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MSP Billing Rules

CMS Issues Reminder on MSP Billing Rules, Appeal Options

  CMS is reminding organizations of Medicare Secondary Payer (MSP) billing and appeal processes after the agency inappropriately denied some claims. Organizations are advised that they must continue to provide services to patients who have open or closed secondary payer records on file or if Medicare inappropriately denied a claim, according to MLN Matters SE21002. Organizations are […]
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Biden’s Administration on COVID-19 Reimbursement

Biden Administration Recommits to COVID-19 Reimbursement

The Biden administration will provide COVID-19 reimbursement to clinicians vaccinating uninsured patients, according to new CMS guidance. The guidance released on Feb. 26, 2021, stated that providers can still seek reimbursement from the FFCRA Relief Fund and the Paycheck Protection Program and Health Care Enhancement Act (PPPHCEA), as well as the Provider Relief Fund, for the […]
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Reimbursement for COVID Testing and Vaccination

CMS Moves to Streamline Coverage and Reimbursement for COVID Testing and Vaccination

Federal officials are ordering plans and insurers to cover testing without cost-sharing – for virtually any purpose. Federal officials have issued new guidance intended to streamline the process through which Americans can get easy, free access to COVID-19 diagnostic testing and/or vaccinations. “This guidance makes clear that private group health plans and issuers generally cannot […]
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Healthcare Automation

Advancements in Automation Are Cutting Into the Rising Costs of Manual Healthcare Transactions

Inefficiency is an issue that continues to plague many areas of healthcare, particularly when it comes to manual administrative functions. While the industry is increasingly harnessing technology – evidenced by the use of telehealth and the push for electronic health record interoperability – administrative complexity continues to be burdensome, and largely paper- and fax-driven. This […]
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Telehealth Security

Best Practices to Ensure Telehealth Security and Protect Patient Data

  To support the sudden increase in test results and medical records being transmitted during the pandemic, hospitals, laboratories, and pharmacies implemented additional devices and remote connections into their networks. After the Office for Civil Rights (OCR) lifted penalties around telehealth to expand care options amid the crisis, new platforms were adopted that were not previously allowed […]
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Social Determinants Lowered ED Utilization

Addressing Social Determinants Lowered ED Utilization in Medicare

A CMS-run care delivery model focused on addressing social determinants of health has effectively identified higher cost and utilization patients while reducing potentially unnecessary emergency department (ED) visits, a new report shows. The Accountable Health Communities (AHC) Model reduced hospital ED visits by 9 percent for Medicare fee-for-service beneficiaries screened for health-related social needs, including housing instability, […]
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Denials Management v Denials Avoidance

Denials Management Versus Denials Avoidance: CDI Can Capitalize

  Typical CDI programs are intended to drive reimbursement through diagnosis securement, contributing to improved case mix index. The COVID-19 pandemic is placing monumental financial stressors upon hospitals, with added costs to treat patients with high acuity and long length of stays, coupled with significant revenue loss associated with postponement of more profitable elective surgeries, […]
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