Tag: Healthcare providers

Two New CPT Codes Effective Immediately

News Alert: Two New CPT Codes Effective Immediately

Reimbursement details have not yet been established. The American Medical Association (AMA) CPT® Editorial Panel has made adjustments to one code and introduced two new codes to enhance the specificity of serology laboratory testing. These codes, released on April 10, are immediately applicable. Reimbursement arrangements for the Centers for Medicare & Medicaid Services (CMS) are […]
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Reducing Patient Billing Disputes

How Hospitals Avoid or Reduce Patient Billing Disputes

CMS’ reworked the Merit-based Incentive Payment System, to simplify reporting requirements for providers in its 2020 Physician Fee Schedule Quality Payment Program Final Rule.Patient billing disputes result in more work for hospital staff and can potentially stand in the way of timely payment for services. However, many organizations are making efforts to avoid or reduce […]
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How To Code EM Levels with Confidence

How To Code E/M Levels with Confidence

How many times has a provider asked you, “What do I need to document to get a 99215?” All too often, medical coders feel they should help their providers understand what elements of documentation are needed to warrant the higher level evaluation and management (E/M) service. Do not do it! If It Isn’t Documented, It […]
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Prevent Billing Errors to Reduce Hospice Claim Denials

Prevent Billing Errors to Reduce Hospice Claim Denials

Effective revenue cycle management can reduce hospice claim denials, particularly those associated with billing or documentation errors. In addition to slowing down payments or losing revenue, submitting inadequate or incomplete required written documentation is a sure-fire way to bring surveyors or auditors to a hospice’s doorstep. As regulators increasingly fix their eyes on the hospice space, providers […]
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Optimizing Revenue Cycle Management

Optimizing Revenue Cycle Management For 2020

With patients seeing higher medical bills than ever and healthcare costs continuing to rise, healthcare organizations need to stay on top of the revenue cycle to ensure they can capture payments and be prepared for changes in 2020. Speaking at the annual meeting of the American Health Information Management Association (AHIMA) in Chicago, Cassi Birnbaum, […]
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Hospitals to Assume Risk in Value-Based Care Models

Verma Presses Hospitals to Assume Risk in Value-Based Care Models

Hospitals assuming downside financial risk under value-based care models is the key to lowering healthcare costs and improving quality, CMS believes. CMS Administrator Seema Verma urged hospitals on Tuesday to accept new value-based care models and price transparency requirements or face greater administrative burden, less competition, and lower reimbursement rates under Medicare for All. “Our choices are […]
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Effective And Profitable Chronic Care Management

How To Deliver Effective And Profitable Chronic Care Management

Chronic care management (CCM) has an overarching clinical goal—improving the health of Medicare patients with multiple chronic conditions. Besides knowing the service parameters, pay rates and usage requirements for CCM codes, physicians must understand how to effectively bill for CCM in order to profitably achieve that goal. Medicare pays for CCM (typically, non-face-to-face) services to […]
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Medicare Advantage Plan Denials

Medicare Advantage Plan Denials: Is That Convoluted or What?

Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons.  I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims.  Answers are also swirling about based on understandings of […]
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