Unexpected and inaccurate medical bills can be alarming and shocking. Whether it’s hundreds or tens of thousands of dollars, when you get a bill for an ER visit or surgery you already paid or don’t owe, it can sometimes be difficult to get answers from the provider or insurance company. All this week KPRC2 consumer […]
A frequent knock on electronic health records (EHRs) has been that they’re just glorified billing systems that fail to provide enough clinical functionality to make a significant difference in the quality of care. So it’s somewhat incongruous that a recent Black Book report on revenue cycle management (RCM) system adoption would say that 26 percent of hospitals don’t have an effective […]
When it comes to a trip to the hospital we all know costs can add up quickly, but do you really know exactly what you’re paying for? Well, since January 1, a federal regulation has required hospitals to post machine-readable documents detailing everything they charge for called chargemasters. Though a debate has been raised into […]
Failing to execute full MACRA implementation by excluding over half of providers is impeding the transition to value-based care, the industry group told Congress. AMGA is urging Congress to enforce MACRA implementation as policymakers intended by no longer excluding providers from the Merit-Based Payment Incentive Program (MIPS). “MIPS was designed as a viable transition tool […]
CMS also has updated its therapy manuals, making elimination of FLR official. Many therapy providers, at hospital outpatient departments and private-practice clinics alike, were reluctant to stop submitting functional limitation reporting codes and impairment modifiers until they could see the guidance clearly written in black and white in the associated therapy policy manuals. While the […]
Planning is underway now for ICD-11. The American Health Information Management Association (AHIMA) has been getting involved in the development of ICD-11 through its participation in the World Health Organization’s (WHO’s) activities, as well as providing members with high-level overviews of what to expect with the new classification system. ICD-11 has yet to be approved […]
Right out of the gate, Medicare Incentive-based Payment System (MIPS) adjustments were incorrectly applied to non physician services and supplies. This error is being corrected by the Centers for Medicare & Medicaid Services (CMS), but what if no one caught it? MIPS eligible clinicians and clinician groups could have improperly lost or gained considerable revenue. […]
In addition to the annual release of CPT® code changes, the American Medical Association (AMA) likes to keep medical coders on their toes by releasing mid-year changes. The following Vaccine codes and Category III codes were accepted and/or revised at the September 2018 CPT Editorial Panel meeting for the 2020 CPT® production cycle. These codes are effective July […]
That statement may appear to be somewhat controversial, but it shouldn’t be. First, plans are required to provide the patient with benefits that are at least as generous as those required under the two-midnight rules. If that were the only factor in play here, I would say it would mean that the patient can’t be […]
There is a new version of the CMS-855I Medicare Enrollment Application, which physicians and non-physician practitioners may begin using immediately. Medicare Administrative Contractors will accept the previous version of the application (7/2011) through April 30, and then require you to use the new version (12/18). What’s Changed? The Centers for Medicare & Medicaid Services (CMS) has made the […]