How Time-Based Billing Impacts Physician Reimbursement for E/M Visits
Time-based billing was associated with higher physician reimbursement for longer evaluation and management (E/M) visits, while billing based on medical decision-making (MDM) led to higher reimbursement...Physicians Slam Fee Schedule Cuts, Call for Medicare Payment Reform
The American Medical Association (AMA) and other physician advocacy groups are calling on CMS to reverse proposed Medicare Physician Fee Schedule updates, which would slash Medicare payment for...Biden Administration Releases Final Surprise Billing Rules
The Biden Administration has released final surprise billing rules implementing the No Surprises Act, a federal law enacted in January 2021 that protects patients from out-of-network medical bills when...AMA Announces CPT Code Update for Monkeypox Vaccines, Testing
The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include a laboratory test CPT code for the orthopoxvirus and two CPT codes for the monkeypox...Claim Denial Rates as High as 80% for Some Marketplace Payers
Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family...Molina Healthcare Pays $4.6M to Settle False Claims Act Violations
Molina Healthcare (Molina) has reached a $4.6 million settlement to resolve allegations that it violated the False Claims Act after submitting improper claims for Medicaid reimbursement. In October...AMA Announces CPT Code for Moderna COVID-19 Vaccine for Young Kids
The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include CPT codes for the Moderna COVID-19 vaccine for children aged six months through five...Sponsored by Veradigm
Choosing the Right Partner to Streamline Revenue Cycle Management
The healthcare industry is highly complex and becoming increasingly so because of changes in legislation, regulation, and coverage. A shrinking workforce is further complicating the ability of provider...AMA Announces CPT Codes for Potential COVID-19 Boosters
The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include CPT codes for two COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline...HHS Reduced Medicare Appeals Backlog by 88% During FY 2022 Q1
HHS ended the first quarter of fiscal year 2022 by reducing nearly 88 percent of the Medicare appeals backlog at the Administrative Law Judge level. According to the Department’s status report...Sponsored by Brault
Preventing Medical Necessity Denials With Clinical Documentation
Healthcare coverage has never been more important, one of the many lessons we’ve learned during the COVID-19 pandemic. And private insurance companies have reaped the benefit of this growing need...Hospitals Saw Substantial Underbilling for Medicare Telestroke Services
Following the Furthering Access to Stroke Telemedicine (FAST) Act, Medicare claims for telestroke services increased in rural and urban emergency departments. However, there was still substantial...Remote Work Propels Electronic Claims Management Adoption
Electronic claims management adoption increased in 2020 as healthcare providers shifted to remote work environments when possible, but they are still leaving billions of dollars on the table in...States with More Uninsured Received Greater COVID-19 Treatment Funding
An analysis published in JAMA Health Forum linked uninsured population size to federal reimbursement for uninsured COVID-19 treatment. The Health Resources and Services...Sponsored by Brault
2022 Claims Reimbursement Updates in Emergency Medicine
Emergency department providers are still reeling from the effects of the ongoing pandemic. But other important updates are also happening in the background—and they are likely to impact emergency...Sponsored by Zelis
Key Ways to Improve Access to Claims Data for a Smoother Revenue Cycle
Healthcare claims contain a wealth of information. Each service line on a claim paints a picture of a patient’s healthcare journey, including their quality of care as well as the cost of that...Sponsored by Zelis
Electronic Payment Key to Streamlining Healthcare Claims Management
The complexity around healthcare claims management is a major pain point for provider organizations, big and small. The increasing cost of claims coupled with a complex system of many payers, each with...Sponsored by Zelis
