Tag: CMS Guidelines

Hospital Price Transparency Compliance

Hospital Price Transparency Compliance Drops Significantly

Compliance with federal price transparency rules among hospitals dropped significantly, from 34.5% in February to 21.1% in November 2024, per a report by Patient Rights Advocate (PRA). This decline highlights the challenges in achieving full Hospital Price Transparency Compliance. The drop is attributed to weak federal enforcement, which has allowed hospitals to obscure pricing information […]
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independent-medical-practices

Maximizing Medicare Reimbursement: Strategies for Independent Practices

In the wake of the COVID-19 pandemic, independent medical practices face many challenges, from adapting to new healthcare methods to major regulatory changes. The main focus of this study is to increase Medicare spending. With the right strategies, independent medical practices can achieve financial sustainability while continuing to provide quality care to their patients. This […]
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Prior Authorization Transformation

How Prior Authorization Transformation Benefits Patients, Providers and  Payers

Prior authorization transformation of consent is a source of worry and concern for everyone involved: patients, members, providers, and payers. What was needed was a structure to coordinate all stakeholders and organize the program. In January 2024, the Centers for Medicare and Medicaid Services (CMS) finalized requirements to expedite the authorization process; this requirement will […]
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Boost Reimbursement with G2211 Add-On Code

Medicare Billing Update: Boost Reimbursement with G2211 Add-On Code

To capture Medicare reimbursement for complex Medicare patient visits, you must know when to use this G2211 Code add-on code. To report the additional time, effort, and related practice expenses associated with caring for Medicare patients across the continuum of care, qualified healthcare providers can begin billing HCPCS Level II codes on Jan. 1, 2024. […]
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The-Evolution-&-Challenges-of-Recovery-Audit-Contractor-Audits

Evolution of Recovery Audit Contractor (RAC) Audits: Challenges, Changes, and Current Landscape

The inception of Recovery Audit Contractor (RAC) audits dates back to 2005, reaching their zenith around 2010 before encountering a deceleration amidst the COVID-19 period. In 2006, Congress granted the Centers for Medicare & Medicaid Services (CMS) the authority to launch the Recovery Audit Contractor program across three initial states: New York, Florida, and California. […]
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Rules for Coding Emergency Department

CMS Rules for Coding Emergency Department Claims | Best Practices

The Centers for Medicare and Medicaid Services (CMS) has consistently authorized hospitals to establish and utilize their own coding guidelines for emergency department facility claims. CMS makes clear that “[a]s long as the services furnished are documented and medically necessary and the facility is following its own system, which reasonably relates the intensity of hospital […]
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three-key-targets-for-payers-during-medicare-open-enrollment

Three Key Targets for Payers During Medicare Open Enrollment

Affordability, simplicity, and accessibility remain the three targets that payers aim to hit during Medicare open enrollment season, according to Christopher Ciano, president of Aetna Medicare. Listen to the full podcast to hear more details. And don’t forget to subscribe on iTunes, Spotify, or Google Podcasts. The push for greater affordability is perhaps most evident […]
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medical-legal-impact-of-2021-em-changes

Medical/Legal Impact of 2021 E&M Changes

Without detailed documentation, providers may face an uphill battle in defending themselves from quality audits and even malpractice issues. Up until 2021, at least for the prior two decades, coders and clinicians relied upon the established Evaluation and Management (E&M) guidelines to determine which E&M code was appropriate for each specific encounter. The 1995 guidelines […]
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