Tag: Healthcare providers

covid-19-monoclonal-antibody-billing-update

COVID-19 Monoclonal Antibody Billing Update

  Ever since a public health emergency (PHE) for COVID-19 was declared on Jan. 27, 2020, there has been several new HCPCS Level II codes created for monoclonal antibody (mAb) products and administration. As confusing as all these new codes and billing requirements have been, nothing has caused as much trouble as the latest change […]
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ahip-warns-proposed-aca-exchange-rule-could-threaten-markets-growing-stability

AHIP warns proposed ACA exchange rule could threaten market’s growing stability

  AHIP, the top lobbying organization for commercial insurers, is warning the feds that provisions in its proposed rule governing the Affordable Care Act’s exchanges for 2023 could “undermine” the growing stability there. For instance, the group says in comments (PDF) submitted late Thursday that potential changes to requirements for essential health benefits would limit […]
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surprised-providers-seek-changes

Surprised Providers Seek Changes to Latest Provisions of the No Surprises Act

Effective January 1, 2022, new billing protections went into effect that have the goal of providing greater protections for patients against surprise medical bills. The Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management (collectively, the Departments) implemented these additional protections that are part of the No Surprises Act […]
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cms-proposes-changes-to-medicare

CMS Proposes Changes to Medicare Advantage and Part D Programs

On January 12, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule, representing CMS’ first major policy proposals for these programs in the Biden Administration. The changes proposed are, overall, modest in scope. In the […]
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ama-challenges-medpac-suggestion-to-freeze-medicare-physician-payment

AMA Challenges MedPAC Suggestion to Freeze Medicare Physician Payment

The industry group states that Medicare physician payment bump will hinder the delivery of high-quality care as providers face financial burdens. MedPAC, a panel tasked with advising Congress on issues impacting the Medicare program, voted to recommend no increase to 2023 Medicare reimbursement rates for physicians. “Temporary or high variable coronavirus effects are best addressed […]
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revenue-cycle-management-2-0-the-key-to-successful-healthcare-finance

Revenue cycle management 2.0: The key to successful healthcare finance

This has, in turn, put greater emphasis on the need for Revenue Cycle Management (RCM) systems to enable a healthcare provider to better manage transactions between payer, provider and patients. It can, through the use of various software platforms, boost revenues, reduce denials and enhance the patient experience. According to a survey published by health […]
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electronic-payment-key-to-streamlining-healthcare-claims-management

Electronic Payment Key to Streamlining Healthcare Claims Management

The complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with their own rules and requirements, creates administrative burdens and obstacles for providers. Ultimately, this complex system impacts the patient experience, as patients must […]
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big-surprises-in-the-no-surprises-act

Big surprises in the No Surprises Act

  In one of the biggest attempts by the federal government to combat surprise medical billing, Congress in late 2020 passed the No Surprises Act (NSA), which imposes a host of new transparency and coverage requirements for employer-sponsored group health plans. Many of the most significant coverage changes were required to be implemented on Jan. […]
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coding-audits-101-how-physicians-can-prepare

Coding audits 101: How physicians can prepare

  You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You provide excellent care for your patients and achieve great outcomes. […]
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