Category: Revenue Cycle Management

Artificial Intelligence in Healthcare Sector

How AI is Lending Hand in Healthcare

Healthcare seems to be important in all areas where Artificial Intelligence (AI) is promising. This likelihood is because healthcare services are overwhelmed by workforce shortages, inadequate medication, increased patient burdens, and inaccurate diagnosis, all of which may help a degree by modern technologies. Imminent prospects for AI in healthcare comprise health assistance and medication management, […]
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hospital price transparency rule

CMS to Audit Some Hospitals for Price Transparency Compliance

CMS is taking steps to ensure hospitals comply with a controversial price transparency rule taking effect on January 1, 2021. On that date, every hospital in the country is expected to provide publicly accessible standard charge information about the items and services they render. That includes gross charges, discounted cash prices, de-identified minimum and maximum negotiated […]
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2021 OPPS Final Rule

OPPS Final Rule Eliminates Inpatient Only List

The 2021 OPPS final rule seeks to increase patient choice and lower out-of-pocket costs. On Dec. 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule for calendar year (CY) 2021. The final rule aims to provide Medicare recipients […]
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COVID-19 Part-B Payment

CMS Updates Part B Payment Information For Covid-19 Treatments

A version of this article was first published December 16, 2020, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders. CMS released new and updated FAQs on Medicare Part B billing and reimbursement for COVID-19 treatments and vaccines. The information updated December 9 is included in Section BB, Drugs and Vaccines under Part B of CMS’ COVID-19 […]
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2021 Medicare Physician Payment Schedule

Final 2021 Medicare Pay Schedule: What Physicians Need to Know

The 2021 Medicare physician payment schedule finalized an AMA-developed approach for less burdensome coding and documenting of office and outpatient evaluation and management (E/M) services. The Centers for Medicare & Medicaid Services (CMS) also extended Medicare payment for many services delivered via telehealth at least until the end of calendar year 2021, but indicated that […]
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Hospital Claim Denials

Hospital Claim Denials Up for Most, Driven by Prior Authorizations

  Hospitals and health systems are facing a growing volume of claim denials, with private plan prior authorization issues driving the recent increase, according to a new report from the American Hospital Association (AHA). For the report, AHA surveyed more than 200 hospitals and health systems in 2019 to understand the impacts utilization management practices employed by […]
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HIPAA Privacy Rule Modifications

HHS Proposes HIPAA Modifications

The Department of Health and Human Services on Thursday unveiled proposed changes to the Health Insurance Portability and Accountability Act Privacy Rule that federal officials say will improve patient access to their medical records, encourage coordinated care and cut red tape. “Our proposed changes to the HIPAA Privacy Rule will break down barriers that have stood in […]
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2021 MIPS Updates

Final Rule Updates MIPS for 2021 and Beyond

  CMS continues to phase in the Quality Payment Program while MACRA mandates loom. The long-awaited Physician Fee Schedule (PFS) final rule, now pending publication in the Federal Register, finalizes proposed updates to the Quality Payment Program (QPP) and its two tracks — the Merit-Based Incentive Payment System (MIPS) and Advanced Alternate Payment Models (APMs) — for performance […]
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MPFS Telehealth Rule

CMS Finalizes 2021 Physician Fee Schedule, Including E/M Changes

After some delay due to the COVID-19 pandemic, CMS has released the final rule for the 2021 Medicare Physician Fee Schedule. The final rule unveiled by CMS yesterday evening will dictate how much Medicare physicians get paid for delivering care starting January 1, 2021. In the rule, CMS finalized a conversion factor of $32.41, which is a […]
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