Category: Blog

Artificial Intelligence Can Make U.S. Healthcare

How Artificial Intelligence Can Make U.S. Healthcare More Efficient

For the past several decades, patients, providers, and payers have lamented the health of the U.S. healthcare system. Just this past fall, JAMA: The Journal of the American Medical Association, estimated that close to 30% of healthcare spending in the U.S. “may be considered waste.”1 Over these same several decades, an important technology — artificial intelligence […]
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New Healthcare Price Transparency Rule

New Healthcare Price Transparency Rule – The Best, Worst, and Most Realistic Case Scenarios

The American Hospital Association has filed a lawsuit to block the rule. On Nov. 15, 2019, the Trump Administration proposed a new healthcare price transparency rule that would basically require hospitals to explain how much a medical service would cost before a patient receives treatment. This rule is due to become effective in January 2021. The […]
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Medicare Advantage and the Medicare Drug Plan

New Directions for Medicare Advantage and the Medicare Drug Plan in 2021

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage plan (MA, or Part C) and the Medicare prescription drug benefit (Part D) program. In years past, CMS has also issued a “call letter,” not subject to the regulatory process, to provide additional information for plans to use […]
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MIPS Changes

What You Need to Know About 2020 MIPS Changes

In November 2019, CMS published the 2020 Quality Payment Program Final Rule (the “2020 MIPS Final Rule Changes”). Below is a summary of some of the most notable changes to the Merit-Based Incentive Payment Program (MIPS). For a complete list of changes, please review the 2020 MIPS Final Rule or CMS’ Quality Payment Program Resource […]
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E_M Coding Guidelines Could Ease Physicians’ Documentation Burdens

How 2021 E/M Coding Guidelines Could Ease Physicians’ Documentation Burdens

Physicians will potentially have a lighter documentation burden and more time to spend with patients in 2021 thanks to an overhaul of Medicare Coding guidelines for outpatient evaluation and management (E/M) services. “The whole point was to have people not document stuff that was not necessary, not relevant to the clinical management of the patient,” […]
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Analytics Find Solution for Healthcare’s Big Data Problem

Will Predictive Analytics Find Solution for Healthcare’s Big Data Problem

Improving data analytics in healthcare has potential includes cost savings and improved patient health and wellness. Here are the two ways through which this improvement can be accomplished: Adopt a business analytics strategy that process huge amounts of healthcare data, rather partnering different analytics tools that results in high IT expense and reduced user adoption. […]
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FESS Codes Claims for Improper Payment Adjustments

Check Your FESS Codes Claims for Improper Payment Adjustments

MACs may be applying the multiple endoscopy rules incorrectly. In the 2020 Medicare Physician Fee Schedule (MPFS) Final Rule, the Centers for Medicare & Medicaid Services (CMS) finalized the proposal to apply the special rule for multiple endoscopic procedures to the family of functional endoscopic sinus surgery (FESS) codes. Practices are now getting remittance advice […]
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Hospital Reimbursement Cuts

Trump Budget Eyes More Site-Neutral, Hospital Reimbursement Cuts

President Trump’s proposed FY 2021 budget includes hospital reimbursement cuts, including more site-neutral payments, as well as a unified post-acute care payment system. President Trump’s proposed budget for the 2021 fiscal year (FY) is stirring up controversy over massive cuts to Medicare and Medicaid spending and proposals to implement work requirements and block grants in Medicaid. But […]
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