‘If you can get it right up front, you’re ensuring accuracy, preventing rework, and preventing denials,’ says Alicia Auman, director of patient access at KSB Hospital. Patient access plays a tremendously important role within...
More InfoDive Brief: A federal appeals court has ruled against UnitedHealthcare, the biggest private payer in the U.S., and reversed a 2018 decision overturning Medicare’s overpayment rule requiring insurers to refund reimbursement to CMS within 60...
More InfoDive Brief: CMS does not have adequate authority to ensure that hospitals will be ready for the next pandemic, and wasn’t able to regulate them well enough to know whether they were maintaining quality and safety during the COVID-19 crisis...
More InfoThe future potential of telehealth hinges on how it’s reimbursed. Virtual care may be popular among patients, but if providers can’t get paid for their services, it’s unlikely they’ll be able to continue to provide them...
More InfoCMS recently added 11 new services to the Medicare telehealth services list, qualifying the services for Medicare reimbursement through the COVID-19 public health emergency (PHE). The new telehealth services cover some cardiac and pulmonary...
More InfoPractices have been creative during COVID-19 to ensure safe patient access: Telephone visits. Curbside immunizations. Drive-up virus testing. Even checking patients in for their in-office visits while they wait in the car. However, each of these...
More InfoMACs may be applying the multiple endoscopy rules incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple...
More InfoNew patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty...
More InfoWith an election year just about upon us, there are a number of changes coming from the current administration that are going to impact healthcare in 2020. Changes in allowable benefits, home health, hospice carve-ins, and new CPT codes for...
More InfoThe Centers for Medicare & Medicaid Services (CMS) announced that, beginning in January 2020, CMS will implement shorter and more frequent HCPCS Level II coding cycles for requests to modify the Healthcare Common Procedure Coding System...
More Info86% of medical group practices in an MGMA report said regulatory burden rose in the last year, with prior authorizations and the Quality Payment Program adding to that burden. A vast majority of medical group practices experienced growing...
More InfoOctober is Breast Cancer Awareness Month. Make sure your practice’s medical coding mammograms for preventive screening mammograms is up to date with current guidelines. Coding Mammograms for Medicare The Centers for Medicare & Medicaid...
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