Category: Blog

Are there “Zs” in your spinal fusion coding? The fiscal year (FY) 2019 ICD-10-PCS updated an area that has not received much attention: Spinal fusion codes. During the Centers for Medicare & Medicaid Services (CMS) Coordination and Maintenance Committee meeting in September 2017, the topic of invalid spinal fusion codes was raised. There were spinal […]

When it comes to artificial Intelligence and machine learning, most often we hear them discussed in a clinical context. But that’s not the only realm where AI and ML could make an impact. In fact, revenue cycle is well-suited to AI and MI. According to Nick Giannasi, chief AI officer for Change Healthcare, it’s almost […]

Three experts on revenue cycle and operations at ASCs gathered at the Becker’s ASC 25th Annual Meeting: The Business and Operations of ASCs conference in Chicago Oct. 19 to discuss how administrators can improve reimbursement per case at their facilities. Here are three pieces of advice they shared on how to avoid claims denials: Be […]

Imagine buying a plane ticket, but the fare only covers your seat, the fuel, the gate attendant, and the peanuts. You have to pay the pilot separately. You are sitting on the plane and, unbeknownst to you, the pilot scheduled to fly your plane is delayed and a pilot from another airline takes over. Because […]

MAs are taking advantage of excessive denials to reduce payments to providers. The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently found that between 2014 and 2016, a total of 75 percent of all appealed Medicare Advantage (MAs) denials were overturned, equivalent to roughly 216,000 denials a year. I […]

Nearly all healthcare decision makers recently surveyed by KLAS said their organization saw financial gains after implementing a clinical documentation improvement solution. Provider organizations are seeing financial improvements after implementing clinical documentation improvement (CDI) solutions, a recent KLAS survey shows. Revenue improved for about 53 percent of healthcare executives, medical records directors and managers, and […]

The big question for many who are new to running and operating an urgent care clinic is how to continue being profitable during a slow flu season in a very competitive market. There are eight key tips urgent care clinics can follow to optimize revenue and remain profitable. 1. Improve RCM: Effective revenue cycle management […]

Medicare claims that do not meet date format requirements will be rejected. The Centers for Medicare & Medicaid Services (CMS) has released date formatting guidelines for the CMS-1500 claim form, which are effective for claims received on or after July 30. When date formatting requirements are not met, Medicare Administrative Contractors will return claims as […]