Computerized artificial intelligence (AI) cut the time primary care physicians spent sifting through patient charts – but helped them feel better prepared for patient visits. The findings were part of a study by the American Academy of Family Physicians’ (AAFP) Innovation Lab. AAFP worked with a computer program developer to test its AI Assistant program […]
On November 2, 2022, the Centers for Medicare & Medicaid Services (CMS) issued CY 2023 Physician Fee Schedule Final Rule (Final Rule), implementing certain updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS) and changes to the Medicare Shared Savings Program (MSSP), effective on or after January 1, 2023. The final […]
In 30 years of running revenue management the usual suspects come up in a Key Performance Indicator (KPI) Dashboard such as Charges, Payments, Adjustments, Net Collection, Gross Collection, Days in AR, AR over 90 Days and Bad Debt. Then you have the breakouts for each category by payer, CPT Code, Location, or ICD Code. There […]
Value-based payment models, including accountable care organizations, bundled payment models, and capitation models, can generate savings for providers and limit healthcare spending. As healthcare spending escalates in the US, stakeholders have started looking at value-based payment models to address rising costs, but many payments are still tied to fee-for-service models, according to a Health Affairs […]
Most providers understand the “No Surprises” requirements for insured patients. Effective as of Jan. 1, 2022, uninsured (or self-pay) consumers are also protected from unexpected high medical bills. If a consumer doesn’t have health insurance or doesn’t plan to use insurance to pay for health care items or services, they must be given a “good […]
Completing all necessary documentation to describe the individual’s current condition, treatment needs, interventions, and medications must be done with precision. The end of a calendar year and the beginning of a new one can be a busy time for healthcare practices, and this year is shaping up to be no different. In much of the […]
Time is running out for Congress to take action on pending legislation dealing with issues that would help primary care across the United States. Six physician groups representing 590,000 doctors across the country sent a joint letter again urging congressional leaders to vote – soon – for bills relating to Medicare reimbursements, prior authorizations, children’s […]
One facility recently found that failing to get an estimate to a patient in timely fashion created more than a few headaches. This past January, immediately after the good-faith price estimate requirement for hospitals went into effect, one of my clients received a call from a patient late on a Friday to schedule a procedure […]
Almost a third of consumers cited inflation as their top reason for being concerned about covering unexpected healthcare costs. More than 70 million adults feel unprepared to pay for healthcare costs, while health systems are facing a tight labor market and ongoing supply chain issues, highlighting the financial repercussions of inflation in the healthcare industry. […]
Payers have been wrongly cutting payments to physicians for evaluation-and-management (E/M) services—often automatically through the use of claim-editing algorithms. A new AMA resource helps physicians fight back against health insurer downcoding. Downcoding happens when a payer changes a claim to a lower-cost service than what was submitted by the physician, leading the practice to get […]