The American Medical Association conducted a survey in late 2021. The results of this 1,000 physician survey show that prior deals made with payers are not being upheld. Continue reading to learn more about the authorization reforms and what this means for insurers. Health insurers are not holding up their end of the bargain on…
The World Health Organization (WHO) has officially released the newest code set in ICD-11, which will be replacing ICD-10. Although the timeframe of the U.S. implementing the new code is uncertain, there is still much to learn about the new code set. Keep reading to learn more. Although the U.S. timeline for implementing ICD-11 is…
As the pressure from Democrats and advocacy groups grew, the Biden administration has begun redesigning a controversial payment model. This model is aimed to present value-based payment structures in standard Medicare, and cancel another Trump-era model that CMS paused early last year. Continue reading to learn more about the redesigns of the controversial Medicare direct…
The year may have just begun but healthcare billing frauds are already running rampant across the nation. Continue reading to learn about nine of the biggest billing fraud cases taking over the headlines. From Cincinnati-based Bon Secours Mercy Health agreeing to pay $1 million to settle allegations that it improperly billed Medicare, to a Florida…
The No Surprises Act (NSA) has been in effect for a little over a month now, but what exactly is the NSA? The No Surprise Act protects patients from balance billing, however, it is not perfect. Keep reading to learn more about the NSA and the controversy surrounding it, along with what is being done…
The ROI from Humana prior authorization platform is driving a nationwide expansion in less than one year. This expansion will improve healthcare processes and costs. Continue reading below to learn more! “This is a re-imagined PA process, one where expedited approval becomes the standard,” says one Humana executive. KEY TAKEAWAYS Humana’s prior authorization platform authorizes…
By: Sheila Haynes, Manager Coding & Compliance Defining Interactive Complexity +90785: Interactive Complexity (+90785) is an add-on code utilized for office visits with a psychologist or other mental health professional that are complicated by language, behavior, emotions, mandated reporting requirements or trauma. +90785 is utilized in addition to one of the following primary service codes…
The No Surprises Act has taken effect and will ensure patients are protected from surprise medical bills. What does the new ban on surprise medical billing mean for you? Continue reading below to learn more! The new year brings new protections for patients with private health insurance who will no longer be blindsided by “surprise”…
By: Sheila Haynes, CPC Coding and Compliance Manager Take notice and prepare for changes to the guidelines for billing split/shared services if your practice’s physicians and qualified health care professionals (QHP) regularly team up for hospital visits. The new guidelines go into effect on Jan. 1, 2022. What is a Split/Shared Visit? Definition of split…
Modifier 25 is an important Evaluation and Management service medical professionals need to understand. It is used for same-day procedures when services beyond usual pre and post-operation are necessary. Continue reading below for a breakdown and examples of modifier 25! By: Sheila Haynes, CPC Coding and Compliance Manager Pay close attention to billing E/M (office…