Incident to billing allows non-physician providers (NPPs) to report services “as if” they were performed by a physician. The advantage is that, under Medicare rules, covered services provided by NPPs typically are reimbursed at 85 percent of the fee schedule […]

Improving revenue cycle management is a key focus for hospitals and health systems as they navigate the shift to value-based care and patients take on more financial responsibility for their care. Becker’s Hospital Review asked RCM leaders at some of these […]

Are you exhausted? Feel cynical toward your job? Tell your boss that you are part of an occupational phenomenon called burnout. But maybe don’t mention it’s in the same category as dust exposure and interpersonal relationship problems.  The World Health […]

The Centers for Medicare & Medicaid Services (CMS) has removed two Healthcare Common Procedure Coding System (HCPCS) codes just days before the bid window opens. Codes E0992 and K0056 have been dropped from the standard power mobility devices product category […]

The shift to value-based care has driven public and private payers to redesign reimbursement models that stress accountability for care quality and healthcare costs. As the fee-for-service environment fades away, alternative payment models like bundled payments are helping to define […]

Carpal Tunnel Syndrome (CTS) refers to the painful condition caused by pressure on the median nerve in the wrist. The median nerve passes through the carpal tunnel, a narrow passageway in the wrist and goes into the hand. The carpal […]

Innovaccer, which develops data tools to help health systems with accountable care and population health management, has published a new research paper focused on the ways advanced machine learning algorithms can improve risk models to better predict the future cost […]

Today the Centers for Medicare & Medicaid Services (CMS) finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM).  ABPM is a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles, allowing a doctor […]

Clinical diagnostic laboratory tests range from routine chemical measurements like blood glucose or sodium to complex examinations for cancer, infectious diseases, or rare inherited disorders. The information they provide is among the most important data doctors use to diagnose and […]

The Department of Justice is taking legal action against hospitals, health systems and technology companies for submitting false claims to Medicare and Medicaid pursuant to the Electronic Health Records Incentive Program, according to the National Law Review. Five things to […]

If you’re an inpatient hospital coder, you’ve got some good news coming your way. Beginning on Oct. 1, 2019, you’ll have 1,322 fewer ICD-10-PCS codes to deal with. That’s because the number of deleted procedure codes — 2,056 in all […]

Value-based payment reform will be the key to lowering healthcare costs and improving care quality, according to health economist Michael Chernew, PhD. At AHIP’s 2019 Institute & Expo in Nashville last week, the Leonard D. Schaeffer Professor of Health Care […]

When we started our medical billing enterprise in 1994 I had no prior experience at billing any medical claims, not to mention secondary and tertiary. I knew nothing. In fourteen years of billing I’ve discovered much and I see from […]

It’s no secret that today’s generation of consumers is much different than 20 years ago (and even 10 years ago). Regardless of what we’re buying or who we’re engaging with, we want communication to be as quick and easy as […]

Understanding why there’s a need for auditing the auditors. I frequently encounter complaints by healthcare providers that when they are undergoing Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), and, more recently, the Targeted Probe-and-Educate (TPE) audits, the auditors are […]

CMS posted changes to the ICD-10-CM codes for fiscal year 2020. Five key points: 1. There were 71,932 ICD-10-CM codes for fiscal year 2019. The update includes 72,184 codes. 2. CMS added 273 codes, deleted 21 codes and made 30 […]

A recent study found that 25% of healthcare organizations don’t encrypt their patient’s data in the cloud. Sharing data is a crucial aspect in the doctor-patient relationship and keeping that information secure and away from prying eyes is not just […]

Nearly eight billion smartphone users on earth and one billion in North America alone are increasing the focus of technologists and businesses towards this high-tech mobility. Smart device applications are developed for nearly all industries that empower you to book […]

The Patient Driven Payment Model is bringing new importance to the ICD-10-CM code set for SNFs. Here’s where the diagnosis codes will come into play. Get a Quick Overview of the PDPM The Patient Driven Payment Model (PDPM) is a […]

The purpose of D5994: Perio Protect is a prescribed medical device used to treat patients who suffer from periodontal disease. The device is lab-created and used as a “tray” to deliver peroxide into a patient’s periodontal pockets. There are many […]

Coding is a major determinant of what dermatologists bill and what they get paid, so it’s critical to keep up with changes to be both compliant and accurate, says Mollie MacCormack, M.D., and Murad Alam, M.D. Demystifying current coding conundrums is even more important as insurers […]

In an effort to reduce healthcare disparities, the American Medical Association (AMA) recently vowed to support the creation of new alternative payment models that specifically address the outcomes of high-risk and vulnerable populations. At its annual meeting on June 11 […]

When the Patient-Driven Groupings Model (PDGM) launches Jan. 1, 2020, leveraging tools and resources to ensure compliance will be critical to a successful transition. Home health care providers already have one helpful tool in place: the electronic health record (EHR). […]

Audits can be an unfortunate reality of practicing medicine. The good news is that as long as you are practicing and coding correctly, you have nothing to fear should you be audited. There are four main types of audits: 1. Medicare Administrative Contractor (MAC) Audits – […]

That’s the contention of the Department of Health and Human Services’ Office of the Inspector General. An OIG audit discovered 34,664 Medicare claims that contained diagnosis codes indicating the treatment of injuries potentially caused by abuse or neglect of Medicare […]

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