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…
There are often questions and confusion on what is included and acceptable when choosing “Drug therapy requiring intensive monitoring for toxicity” in the Medical Decision-Making Risk category for Evaluation and Management coding. This article reviews the definition and guidelines as provided by CMS and their Medicare Administrative Contractors (MACs). Risk: High MDM – Drug therapy…
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…
New developments from the Centers for Medicare & Medicaid Services (CMS) regarding policy changes were released earlier this month. The proposed changes will effect drug programs in 2023 to create more helpful options for Medicare Advantage and Part D consumers. Continue reading below to learn more about the notice. The Centers for Medicare & Medicaid…
Global OB Care Coding and Billing Guidelines By: Sheila Haynes – Coding and Compliance Manager The total obstetric care package, commonly referred to as “Global OB Care”, includes the provision of antepartum care, delivery services and postpartum care. When the same group physician and/or other healthcare professional provides all components of the OB package, the…
Private practice physicians may not have the upper hand when it comes to financial aids that other publicly owned facilities do, but according to a recent study, these private practices may, however, hold the key to high-performing facilities that other big health systems should pay attention to. Keep reading to learn more as to how…
Recently announced, the third dose of the Pfizer vaccine was approved for pediatric patients between the age of 5 and 11. A recently issued statement by federal agencies urges all eligible children and teens to receive the vaccine. Continue reading below to learn more. The American Medical Association (AMA) today announced an editorial update to…
Worried about how to protect your wallet from surprise medical bills? The new No Surprise Act was passed recently and many still do not understand what it truly means for them. Luckily, a couple of organizations have added No Surprise Act resources that will help people comprehend the new act. Continue reading below to find…
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…