Month: September 2021

As Revenue Cycle Management Expands, Automation Is Key

As Revenue Cycle Management Expands, Automation Is Key

  In its simplest form, revenue cycle management is the process healthcare providers use to ask for, track, and collect revenue for services rendered to patients. But as medical billing gets more complex, revenue cycle management is expanding beyond the business office. At Jackson Hospital in Montgomery, Alabama, for example, revenue cycle management also includes […]
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No Surprises Act Notice Requirements: The Good and Bad News for Providers

No Surprises Act Notice Requirements: The Good and Bad News for Providers

Surprise billing occurs when patients receive care from out-of-network providers without their knowledge. On July 1, the Biden Administration passed an interim final rule: the first portion of the “Requirements Related to the Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule […]
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2021 E/M Changes: Are You Coding Unique Tests Properly?

2021 E/M Changes: Are You Coding Unique Tests Properly?

Review the AMA’s updated definition of what constitutes a unique test. Many coders are asking the question, “What is a unique test?” As always, we must first turn to the guidelines to see how “test” is defined. In the original published guidelines, the American Medical Association (AMA) stated: “Tests are imaging, laboratory, psychometric, or physiologic […]
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Steps Employers Can Take To Implement Advanced Primary Care

Steps Employers Can Take To Implement Advanced Primary Care

Advanced primary care can help employers control costs and coordinate care, but many employers do not know how to start and scale such a solution in their employer-sponsored health plans, according to a report from the Duke-Margolis Center. Primary care is an essential part of preventing high-cost health conditions among employees. However, only slightly more […]
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AMA Issues More COVID-19 Vaccine Codes

AMA Issues More COVID-19 Vaccine Codes

 The American Medical Association’s (AMA’s) CPT® Editorial Panel has released eight new COVID-19-related codes to report a new formulation of the Pfizer vaccine, a Moderna booster vaccine, and a Pfizer booster using either the new or old formulation. These codes are in addition to the four new CPT codes released last month and the many […]
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Prime Healthcare hospitals cut ties with UnitedHealthcare, citing low reimbursement

Prime Healthcare hospitals cut ties with UnitedHealthcare, citing low reimbursement

Prime’s New Jersey hospitals will continue to honor the rates and services in the agreements until the end of the cooling off period. The decision impacts Saint Clare’s Health in Denville, Dover and Boonton, Saint Michael’s Medical Center in Newark, and Saint Mary’s General Hospital in Passaic. Dr. Sonia Mehta, regional CEO and chief medical […]
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Hospitals And Health Systems Projected To Lose About $54B In Net Income In 2021

Hospitals And Health Systems Projected To Lose About $54B In Net Income In 2021

Sicker patients, fewer outpatient visits, and higher expenses for labor, drugs, and supplies will continue to damage the financial health of hospitals and health systems throughout 2021, says a new analysis released today by the American Hospital Association (AHA). Hospitals nationwide will lose about $54 billion in net income over the course of the year, […]
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High Healthcare Spending Shifts to Uninsured, Prescription Drugs

High Healthcare Spending Shifts to Uninsured, Prescription Drugs

In nearly two decades, the overall concentration of healthcare spending has remained steady, but there has been an increase in the concentration of prescription drug spending, according to a study in JAMA Network Open. To find the concentration curves of cumulative percentage of healthcare spending versus percentage of ranked population, researchers analyzed data sets from […]
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The Changing Landscape of Healthcare B2B Payment Transactions

The Changing Landscape of Healthcare B2B Payment Transactions

Healthcare B2B payment transactions have been high in 2021, potentially signaling the importance of electronic payment transfers as the nation emerges from the coronavirus pandemic, according to a report from National Automated Clearing House Association (NACHA). Nacha oversees the ACH Network, a national payment system. B2B payments made through this network in the healthcare industry […]
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Lack of Healthcare Interoperability Hinders Electronic ACO Reporting

Lack of Healthcare Interoperability Hinders Electronic ACO Reporting

CMS is looking to modernize the ACO reporting process by mandating the use of electronic clinical quality measures (eCQMs). However, accountable care organizations (ACOs) are concerned that the lack of healthcare interoperability will make electronic ACO reporting near impossible. “CMS must avoid making eCQMs mandatory until standard data fields exist across EHRs, and true interoperability […]
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