Tag: Reimbursement

CMS Unveils New MIPS ‘Framework’ Aimed at Reducing Reporting Burden

The Trump administration has proposed updates to the Merit-based Incentive Payment System (MIPS) it says would ease the quality reporting burdens in the program. The Centers for Medicare & Medicaid Services (CMS) introduced a new framework for MIPS called MIPS Value Pathways (MVPs) with the goal of making it easier for physicians to participate in the program. Under […]
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Medical Necessity and Denial Management

Quality work reduces the burden of the denial management process. When my children were young, they really enjoyed the movie “The Neverending Story.” It’s about a boy who reads a magical book that tells a story of a young warrior whose task is to stop a dark force called “The Nothing” from engulfing a mystical […]
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Increase Reimbursement, Reduce Take-Backs With These 4 Steps

In general, urologists are doing quite well financially. The laws of supply and demand have finally caught up with the profession, as we had predicted years ago. However, you could do better. How can urologists increase their income? In this article, we share with you steps you can take to increase your income, and, at […]
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Thinking Strategically About MACRA and MIPS: Will it Be Sink or Swim in 2019?

In Part One of this two-part article exploring the implications of MACRA for healthcare providers, healthcare leaders and health IT experts discuss why it’s critical for clinicians to think strategically, rather than tactically, about MACRA compliance. Numerous industry surveys have highlighted that U.S. physicians, by and large, remain unprepared for managing and executing Medicare Access […]
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CMS Releases FY 2020 ICD-10-PCS Codes Set

CMS released the fiscal year (FY) 2020 ICD-10-PCS changes on Friday, May 31, which include two code revisions, 734 additions, and 2,056 invalidations. The files include information on ICD-10-PCS updates that all inpatient coders must use for discharges occurring from October 1, 2019, through September 30, 2020. The total number of ICD-10-PCS codes for 2019 was 78,881. […]
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Take Your Revenue Cycle To The Next Level With Robotic Process Automation

To remain fiscally viable, hospitals and health systems must ensure reimbursement is collected properly and in a timely fashion. Healthcare’s “perfect storm” — the ever-increasing cost of care paired with the complexity of technology and rising expenses — has intensified this pressure, according to David Millen, vice president of information technology and digital transformation at […]
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Pain Management and The Global Period

Pain management during the global period of a procedure, if related to that procedure, is not separately reportable. If a provider other than the operating provider performs follow-up care, you must be careful to avoid “unbundling” of that follow-up care. The global period, or global surgical package, bundles all care typically related to surgical service into a […]
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What’s New In 2019 For CMS

This year’s reporting for the Quality Payment Program will affect the 2021 payment year. Kevin J. Corcoran, COE, CPC, CPMA, FNAO, delivered his annual update at Hawaiian Eye 2019, highlighting changes CMS would be making this year for coding, payment issues, regulatory matters, administrative issues and reimbursement issues. The Medicare Physician Fee Schedule did not […]
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Top 13 Reasons For Claim Denials

Top 13 Reasons For Claim Denials

Denied claims are one of physicians’ chief complaints when it comes to dealing with payers. To a certain extent, every practice deals with claim denials. It’s those practices that eliminate the most common reasons that experience a smoother revenue cycle and find greater financial success. Here are the 13 most common reasons for why claims […]
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Urgent Need for New Revenue Streams will Shape Providers Strategies

Building alternative revenue streams source will play a bigger role in healthcare providers’ strategies, according to a new study. Ninety percent of hospital and health system executives surveyed indicated that new revenue streams were an urgent priority expected to yield a return in the next three years, a new study from Boston-based Partners Health Care […]
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