Using automated deep learning software, physicians without any background in computer programming were able to develop effective artificial intelligence technology for medical image diagnostic classification, a recent study found. As described in The Lancet Digital Health, scientists trained a deep […]

Expect more aggressive reviews of materials beyond the three-day criteria. Today I want to talk about skilled nursing facility, or as we often call them, “SNF” stays. For this, I’d like to start at the beginning. I’ll go all the […]

Santa Monica, Calif.-based Oceanside Medical Group failed to comply with Medicare requirements when billing for psychotherapy services, according to a report from HHS’ Office of Inspector General. The OIG said none of the 100 sampled beneficiary days, consisting of 103 […]

Hospitals have relied on a relatively manual process and retrospective audits for coding compliance, but new technology is streamlining the process, allowing providers to get ahead of denials. Healthcare technology is credited with advancing clinical care, allowing providers to detect […]

Pediatrics will see some important changes to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) that will take effect on Oct. 1. These include updates to both the tabular and the code set. Tabular updates An important clarification […]

The revolution in Blockchain technology has made its way to the healthcare industry and is already showing promising results in the technical advancements in health care. Healthcare Rallies For Blockchain, a study from IBM, found that 16% of surveyed healthcare executives have […]

The announcement is all but ensured to trouble providers already concerned about overreach. Federal healthcare oversight authorities have announced that they are expanding their “revocation and denial authorities” in an effort to enhance their efforts to fight waste, fraud, and […]

A look at the proposed Medicare Physician Fee Schedule. As you may be aware, the proposed Medicare Physician Fee Schedule (MPFS) rule for 2020 was officially published on Aug. 14, 2019.  There are many components to the rule, including a […]

A recent AMA study found that in 2018, for the first time, employed doctors outnumbered those that owned, or had an ownership stake in, a practice. For independent practices, this milestone highlights the importance of operating as efficiently as possible. […]

Poor healthcare IT infrastructure has contributed to patient care problems at Indian Health Service (IHS) hospitals, concluded a recent report by the HHS Office of Inspector General (OIG). The report found that the IHS had insufficient healthcare IT infrastructure to […]

HIV/AIDS payments, in particular, are under the microscope. The new Patient-Driven Payment Model, or PDPM, makes radical changes to the Medicare payment model for nursing homes. One of the largest changes is the reimbursement rate for services provided to HIV […]

Care coordination and planning are becoming increasingly important to caring for the millions of Medicare beneficiaries suffering from two or more serious health conditions, such as diabetes and heart disease. But many providers believe that current Medicare billing codes do […]

When your job is converting medical documentation into codes, your knowledge of medical anatomy has to be shipshape. But you’ve got the added complication that the code set you’re using may have its own definitions for specific terms. Case in […]

In countries like the US, citizens are investing in health insurance plans, which are directly increasing the demand for medical coders’. Recently got an opportunity to interact with a few life sciences students. That is when I asked a student […]

Prior authorizations consume hours of physician time as they seek insurer approval for drugs and treatments. Health plans say prior auths improve the quality of care and manage healthcare spending, but doctors say they infringe on their autonomy and take […]

CMS has provided ICD-10 Procedure Coding System updates for the fiscal year beginning Oct. 1, 2019, and ending Sept. 30, 2020. Four takeaways: 1. The updated ICD-10-PCS codes are for discharges taking place in fiscal year 2020. 2. There are […]

The case continues even after two suicides. When does an audit go beyond the reasonable and become persecution? An act of tyranny by claim denial and extrapolation? Vernon Partners LLC (name changed for reasons of confidentiality), a medical provider in […]

There are 2,115 additions to the third quarter Medicare National Correct Coding Initiative (NCCI or CCI) practitioner edits that became effective July 1, 2019. The good news is that the bulk of the new edits affect a comparatively small number […]

The stories of Americans affected by surprise medical bills are hard to believe. A teacher with insurance was taken to an out-of-network medical facility when he suffered a heart attack and was charged $108,951 out-of-pocket for his care. A college […]

On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or […]

As the industry grapples with solutions for high patient financial responsibility and healthcare costs, it has become laser-focused on one key, unifying issue: surprise medical billing. A surprise medical bill is a charge that a patient did not expect to […]

Where the burden lies could make a difference when it comes to the RACs. In a legal lawsuit, one party is initially presumed to be correct and gets the benefit of the doubt, while the other side bears the burden […]

Tina R. Strawn, RN, administrative director of operations for patient financial services at Houston-based Harris Health System, has 27 years of healthcare experience. Throughout her career, she has worked in patient care, bed management, transfer center coordination, case management, nurse […]

It’s every physician’s worst nightmare: Receive payment for services rendered, but then a payer identifies an aberrant pattern in claims data, audits the records, decides it has overpaid the practice, and recoups those funds. That money you already allocated for […]

Another day, another change to E/M plans for 2021! Medicare has released the 2020 proposed rule for the Medicare Physician Fee Schedule (MPFS), bringing in the recent AMA plan to revise E/M coding in 2021. But what does the MPFS […]

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