Surprise billing occurs when patients receive care from out-of-network providers without their knowledge. On July 1, the Biden Administration passed an interim final rule: the first portion of the “Requirements Related to the Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule […]
Omnichannel strategies are becoming increasingly significant to successful member engagement. What is omnichannel engagement? Omnichannel engagement is a strategy that originated as a sales and marketing term but has infiltrated various sectors of the healthcare industry with the rise of healthcare consumerism. This strategy involves using various consumer touchpoints to push a product in a […]
Revenue is not a goal; it is an outcome. Healthcare providers, hospitals and other services, have struggled for the last decade to maintain sustainable revenue for survival. This has been exacerbated by the pandemic changing borderline net revenue to worsening losses. Many have instituted new practices to acquire more revenue not realizing increased revenue is […]
As promised, this is a follow-up to our first blog post on the new federal transparency requirements. In our prior post, we summarized the Hospital Price Transparency rule which went into effect on January 1, 2021, and here we discuss the transparency rules contained in the Consolidated Appropriations Act, 2021 (the “Act”), which apply to both health plans […]
CMS recommends that organizations review the agency’s most recent guidance on telehealth billing. CMS is reminding providers to ensure that Medicare claims for telehealth are correctly billed. The agency issued broadly expanded telehealth services as part of its response to the COVID-19 public health emergency. However, a 2018 Office of Inspector General audit found that CMS […]
Some providers are taking steps to serve those that have historically been neglected. When examining the big picture of our society, rural America is grossly under-represented in many ways. While areas defined as “rural” comprise 80% of the total US land area, its inhabitants comprise only 20% of the US population (US Census Bureau) In other words, […]
Electronic Prior Authorization can have a positive impact for both physicians and patients. America’s Health Insurance Plans (AHIP) published a news release stating that an analysis of the E-prior authorization process found that it was able to significantly reduce the time between a request for authorization and a decision and the time between the […]
Starting January 1, 2022, healthcare providers will be subject to a new surprise billing law that makes it illegal for providers to bill patients more than in-network cost-sharing for out-of-network services and establishes an arbitration process to resolve unexpected out-of-network charges. The law, the No Surprises Act, was passed in December 2020 as part of […]
The latest $1.9 trillion COVID-19 relief package includes several provisions advantageous to healthcare providers but will leave them to face significant Medicare spending cuts in the future. Passed by the House yesterday, the American Rescue Plan Act of 2021 will funnel $8.5 billion to reimburse rural healthcare providers for expenses and lost revenues attributable […]
The COVID-19 relief bill the House passed Wednesday is a major win for various sectors in the healthcare industry, and includes the biggest update to the Affordable Care Act since it was enacted 11 years ago this month. The $1.9 trillion American Relief Plan was approved by a party line vote of 220-211, having made […]