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Anthem is opting to change its name to better reflect its purpose in the healthcare business. Its new name Elevance Health will better represent what the insurance company has evolved into; a lifetime trusted health partner for the millions of people they provide to. Continue reading to learn about this change. Anthem is changing its…
DetailsThe 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…
DetailsAs 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…
DetailsThe place of service (POS) code set provides location information necessary to pay claims correctly. There are times when the health care industry requires a greater need for specificity than Medicare. While Medicare may not require this greater specificity to process and pay claims, it will adjudicate claims with the new codes in order to…
DetailsThe 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…
DetailsThere 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…
DetailsThe 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…
DetailsNew 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…
DetailsGlobal 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…
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