Medical Billing

Medical Bills Are Confusing for Nearly 40% of Adults, Survey Finds

by Victoria Bailey

Almost 40 percent of Americans are confused by their medical bills, with many feeling uncertain about what they are being billed for or if they will be able to pay, according to a survey conducted by...

OIG: Labs Billed Medicare Part B for High Levels of Diagnostic Tests

by Victoria Bailey

More than 370 labs submitted Medicare Part B claims that included questionably high billing for COVID-19 and additional diagnostic tests, a report from the Office of Inspector General (OIG)...

HHS Gives Providers More Time for Good Faith Estimate Compliance

by Jacqueline LaPointe

HHS has extended enforcement discretion for the delivery of some good faith estimates (GFEs) under the No Surprises Act, according to new guidance. The guidance released by HHS on Friday says that CMS...

House Committee Requests Changes to Final Surprise Billing Rule

by Victoria Bailey

Leaders of the House Committee on Ways and Means have voiced concerns that the final surprise billing rule on the independent dispute resolution (IDR) process continues to violate the No Surprises...

NY Gov. Signs Legislation Prohibiting Property Liens Over Medical Debt

by Victoria Bailey

New York Governor Kathy Hochul has signed legislation aiming to protect patients with medical debt from facing wage garnishment or liens on their property. “No one should face the threat of...

MGMA Requests Modifications of Good Faith Estimate Requirements

by Victoria Bailey

The Medical Group Management Association (MGMA) has asked HHS, the Department of Labor, and the Department of the Treasury (the Departments) to modify the good faith estimate (GFE) and advanced...

Improper Payment Rate for Federally Facilitated Exchange Fell Under 1%

by Victoria Bailey

The improper payment rate for the federally facilitated exchange (FFE) program was less than 1 percent in 2020, according to the annual 2022 Agency Financial Report from CMS and HHS. Improper payments...

Connecting Payers, Providers, and Tech for a Better Patient Financial Experience

by Victoria Bailey

The patient financial journey can be lengthy and confusing for consumers following a healthcare encounter, making it a critical area of improvement for providers and their revenue cycle management teams. Streamlining the patient financial...

OR Nonprofits Impede Patient Access to Financial Assistance Programs

by Victoria Bailey

Oregon nonprofit health systems are failing to comply with state laws and engaging in practices that make it difficult for patients to access financial assistance programs and avoid medical debt, a...

Consumers are Unaware of Available Financial Assistance for Medical Bills

by Victoria Bailey

Almost two-thirds of consumers do not know if their physicians or hospitals offer financial resources such as payment plans or financial assistance programs to help cover medical bills, according to a...

Some State Surprise Billing Resolution Processes Favor Providers

by Jacqueline LaPointe

The No Surprises Act gives states the opportunity to enforce surprise billing provisions, but most are leveraging the federal independent dispute resolution process to determine out-of-network rates,...

Why Text-to-Pay is a Key Resource in the Patient Collections Toolbox

by Jacqueline LaPointe

The revenue cycle management department at MainStreet Family Care in Alabama has a mission, and that is to give patients every opportunity to pay their financial responsibility. “We give the patient every opportunity that we can and...

Medical Coding is the Next Stop for Artificial Intelligence in Healthcare

by Jacqueline LaPointe

To a layperson, medical codes look like a different language, and in a way they are. Medical coding is a highly complex process in healthcare in which clinicians and revenue cycle staff work together to translate clinical encounters into...

3 Trends from the Revenue Cycle Management Virtual Summit

by Jacqueline LaPointe

Patient financial experience, denial prevention, and remote work are major challenges for healthcare organizations, according to healthcare leaders at this year’s Revenue Cycle Management Virtual Summit. The Summit took place on...

TX Doctors Sue Feds Over Surprise Billing IDR Process, Again

by Jacqueline LaPointe

The Texas Medical Association (TMA) is once again suing the federal government over the surprise billing law enacted earlier this year. TMA sued federal regulators and won last year. At the time, the...

US Rep. Urges HHS to Investigate Medicare Fraud Scheme by HCA

by Victoria Bailey

US Representative Bill Pascrell, Jr. (D-NJ-09), Chairman of the House Ways and Means Subcommittee on Oversight, has asked HHS to investigate a possible billion-dollar Medicare fraud scheme committed by...

State Surprise Billing Laws Impact Out-of-Network Provider Charges

by Victoria Bailey

State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges for...

AMA Releases 2023 CPT Code Set, Aims to Reduce E/M Coding Burden

by Jacqueline LaPointe

The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains updates that aim to reduce medical coding burden for evaluation and...

How Time-Based Billing Impacts Physician Reimbursement for E/M Visits

by Victoria Bailey

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...