The Centers for Medicare & Medicaid Services (CMS) has finalized its 2025 Medicare Physician Fee Schedule, which includes a 2.9% Medicare Physician Pay Cuts to physician payments. This decision, despite opposition from major industry groups, will impact healthcare providers and potentially patient access to care. The rule also includes several positive provisions, such as expanded […]
In the realm of healthcare billing and coding, modifiers are crucial tools used to provide additional context and specificity to procedure and diagnosis codes. These modifiers help healthcare providers accurately communicate the nature of services rendered to payers. Two commonly used modifiers, Modifiers 26 and Modifier TC, play significant roles in clarifying billing practices and […]
The International Classification of Diseases, Tenth Revision (ICD-10), is the cornerstone of modern medical diagnosis coding. Staying informed about ICD-10 Updates is crucial as healthcare becomes more complex and data-driven. Understanding the changes in ICD-10 is essential for everyone involved—from healthcare providers and medical coders to hospital administrators and insurance companies. Every year, the World […]
The healthcare industry has long been burdened with paperwork, from patient intake forms to insurance documentation. While many healthcare providers have already adopted Electronic Medical Records (EMRs), there’s a growing realization that going paperless can extend far beyond just digitizing patient records. One significant area where healthcare can continue to evolve is through the use […]
Using surgery modifiers to accurately represent the role of assistant surgeons has become increasingly important over the past three decades. Initially, a simple mention of the assistant surgeon’s name in the operative note header sufficed. However, as the healthcare landscape evolved, payers began demanding more granular details about the assistant surgeon’s role and contributions to […]
The Centers for Medicare & Medicaid Services (CMS) recently announced plans to continue allowing certain telehealth flexibilities beyond the end of 2024. These changes are part of their proposed rules for Medicare payments in 2025. While most temporary telehealth rules from the COVID-19 pandemic are set to expire, CMS wants to keep some in place. […]
Independent physicians, while passionate about patient care, often find themselves entangled in the intricate web of financial management. This has become increasingly challenging with the shift towards value-based care and the growing complexity of payer contracts. Outsourcing Revenue cycle management (RCM), the process of managing financial operations from appointment scheduling to claim settlement, has emerged […]
The healthcare industry is on the verge of a significant transformation as we approach 2024: transitioning from ICD-10 to ICD-11. Healthcare providers, payers, and patients alike will all be impacted by this shift, which promises to revolutionize the way medical diagnoses and treatments are documented and reported. Our comprehensive guide explores the intricacies of ICD-11, […]
The financial impact of VBC is profound, necessitating adjustments in how providers approach and manage their financial operations to align with this new model of care. The healthcare industry is shifting towards value-based care (VBC), a model that prioritizes high-quality care while aiming to lower costs. In contrast to the traditional fee-for-service model, value-based care […]
A proposal to track prior authorization using CPT codes was pulled back for revision after a surprising finding. An urologist, advocated for the plan to compensate physicians for time spent on prior authorization requirements. He also hoped it would streamline the process and improve patient care. However, the American Medical Association (AMA) informed urologist that […]