Category: Revenue Cycle Management

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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Flexible 2021 MPFS rule

2021 Medicare Pay Schedule Eases Physicians’ Documentation Burdens

The final 2021 Medicare physician payment schedule includes a simpler, more flexible process for coding and documenting evaluation and management (E/M) office-visit services. But those positive changes, set to take effect in January, are accompanied by significant pay cuts for many physicians in specialties that provide relatively few office visits—cuts that come as the pandemic […]
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2021 Medicare Payment Changes

Physician Groups Say Changes to Medicare Payment are Key for Primary Care

  The American College of Physicians (ACP) and other physician groups have written a letter to congressional leaders urging the implementation of essential changes to Medicare payments set to take effect Jan. 1. According to a news release, the Medicare Physician Fee Schedule for 2021 includes changes to Medicare payments for office visits and related evaluation […]
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AI in COVID19 Pandemic

How AI is Solving Big Challenges During COVID-19

Artificial intelligence is changing the way we think about healthcare during the COVID-19 pandemic, opening our eyes to new opportunities to use machine learning to draw useful conclusions faster. Before COVID-19, one of the biggest challenges healthcare organizations faced was how to accelerate and scale their application of AI—clinically and operationally. Now, the use cases […]
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