Category: Blog

Majority of Hospitals Set to Receive Increased Payments

Most Hospitals Will See Positive Payments in 2019

U.S. hospitals that are putting quality over quantity will fare well next year for their efforts. Out of  approximately 2,800 hospitals across the country, more than 1,550 will see an increase in their 2019 Medicare payments. For the rest? Well, the news isn’t so good. Where Does The Money Come From? The Centers for Medicare […]
Maximizing Medicaid Expansion Benefits

Maximizing Medicaid Expansion Benefits

Three more states voted in this previous election to expand Medicaid. Virginia will be going forward with Medicaid expansion on January 1, 2019. Though Medicaid reimburses you at a very low rate, they will pay more than most self-pay patients and the cost to collect is much lower. The payer mix shifting from uninsured to […]
Spinal Fusion Codes

ICD-10 Coding: New Character Surfaces in Spinal Fusion Codes

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 […]
Artificial Intelligence Health Outcomes Challenge

CMS to Launch Artificial Intelligence Health Outcomes Challenge

CMS is teasing a new cross-industry challenge to identify innovative strategies for using artificial intelligence to improve health outcomes. The CMS Innovation Center is gearing up to launch a new industry challenge aimed at identifying new strategies for leveraging artificial intelligence and machine learning to improve outcomes. The proposed challenge will explore how artificial intelligence […]
3 Tips To Manage Claims Denials At ASCs

3 Tips To Manage Claims Denials At ASCs

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 […]
Reimbursement

E&M Flat Rate Reimbursement Delayed to 2021

For 2019 and 2020, we will see no changes to our outpatient, office-based evaluation and management (E&M) services, but things will change come 2021 – that according to the E&M Final Rule released Thursday by the Centers for Medicare & Medicaid Services (CMS). Since 2004, CMS has stated through the Claims Processing Manual that medical […]
Are Medicare Advantage Plans Creating Excessive Denials

Are Medicare Advantage Plans Creating Excessive Denials?

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 […]