The False Claims Act settlements alleged that the healthcare organizations knowingly submitted improper Medicaid claims for services provided to California’s Medicaid expansion population. A California county organized health system and three healthcare providers have reached a $70.7 million settlement to resolve allegations that they violated the False Claims Act by submitting fraudulent claims to California’s […]
The average cost per employee is estimated at $13,800 Employers are expected to pay a lot more for employee health insurance in 2023. A study by a professional services firm estimates a 6.5% increase resulting in an average of $13,800 per employee. The 6.5% increase is double the 3% most employers saw in 2021 and […]
The new codes and subsequent issues will be effective Oct. 1, 2023. According to senior healthcare consultant Laurie Johnson, who presented the information during the series, three major issues emerged from her research and manifested themselves in her presentation —a presentation that was augmented with commentary from Erica Remer, MD, co-host for the long-running […]
The final surprise billing rules downgrade the weight the QPA has on out-of-network payment determinations and establishes documentation requirements for down coding situations. The Biden Administration has released final surprise billing rules implementing the No Surprises Act, a federal law enacted in January 2021 that protects patients from out-of-network medical bills when they seek care […]
Prior authorizations and Medicare reimbursements are some of the most consistently cited sources of issues at primary care practices. Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), joined us in April to discuss his organization’s lobbying efforts. The following interview has been edited for length and clarity. Medical […]
MGMA report shows value-based contracts account for $30,922 per provider The Medical Group Management Association released a report looking at the proliferation of value-based contracts and how quality metrics tie-in to revenue. The report, 2022 MGMA DataDive Practice Operations, shows that revenue from value-based contracts accounted for varying amounts of total medical revenue in 2021 […]
Hospitals are increasingly utilizing locum tenens physicians, advanced practice providers (APPs), and telehealth services to address staffing shortages. The Innovation & Flexibility: Journey to Sustainable Healthcare Report reflects data from 129 healthcare administrators representing a range of facility types and sizes. The COVID-19 pandemic exacerbated hospital staffing shortages as many clinicians faced burnout and […]
More than half of economists agree that the U.S. economy is headed for a downturn. Contrary to popular belief, the healthcare sector has never been recession-proof. Reports indicate that the healthcare industry is affected later in a recession and has a longer recovery period. Compared to other healthcare facilities, like hospitals and emergency rooms, independent […]
When ICD-10-CM is updated Oct. 1, so are these National Coverage Determinations. Are you wondering which National Coverage Determinations (NCDs) will be affected by the thousands of diagnosis code changes going into effect Oct. 1? Centers for Medicare & Medicaid Services (CMS) transmittal tells all. CMS Transmittal 11546, issued Aug. 4, is a one-time notification […]
A major revision of the Current Procedural Terminology (CPT) Evaluation and Management (E&M) Guidelines for Office and Outpatient Visits (O/O Visits), Split/Shared Visits, and Critical Care Time billing was implemented Jan. 1, 2021. You would think that all office-based providers would have been made aware of this and changed their documentation accordingly, but there is […]