Month: January 2022

Health Equity and SDOH: A Payer Perspective / Update

Health Equity and SDOH: A Payer Perspective / Update

As part of its ongoing mission to improve the health of America, the Blue Cross Blue Shield Association (BCBSA) announced its National Health Equity Strategy in April 2021 to confront the nation’s crisis in racial health disparities. This strategy is intended to change the trajectory of health disparities and reimagine a more equitable health care […]
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Study examines differences in coverage denials for traditional Medicare, MA

Study examines differences in coverage denials for traditional Medicare, MA

Traditional Medicare coverage rules make up the bulk of denied services and spending compared to a Medicare Advantage plan, according to a new study in the latest Health Affairs issue. The study, led by the University of Pennsylvania, Harvard University and CVS Health, relied on Medicare Advantage claims that were denied for beneficiaries enrolled with […]
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When To Report an Incidental Finding

When To Report an Incidental Finding

DOJ lawsuits may be your road map to risk adjustment compliance. The growing prevalence of risk adjustment in healthcare has forged new processes in documentation practices that have resulted in many organizations adopting practices that bend the cast iron rules for ICD-10-CM coding. We are starting to see some of the long-term dangers of ambitiously […]
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Understand Critical Care Before You Code

Understand Critical Care Before You Code

A solid understanding of guidelines and COVID-19-related complexities will limit claim denials and audits. Deciphering documentation to determine what qualifies as critical care services can be challenging for medical coders and auditors. With limited critical care codes available for assignment, reporting may appear relatively straightforward at first glance. However, there are many considerations that coders […]
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Get Caught Up on Coding and Billing News

Get Caught Up on Coding and Billing News

New COVID-19 vaccine status codes, changes and corrections to the 2022 CPT code set, Medicare Physician Fee Schedule (MPFS) payment changes, and prior authorization code list changes — that’s what’s on the agenda this month. Read all about it! 3 New Codes Improve COVID-19 Vaccination Status An April 1, 2022, update to the 2022 ICD-10-CM […]
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