Category: Blog

Medpac Suggests Cutting Medicare Reimbursement For Stand-alone Emergency Departments The Medicare Payment Advisory Commission (MedPAC) recently voted to reduce Medicare reimbursement by 30 percent for off-campus stand-alone emergency departments (ED) in urban areas. The recommendation will be included in the commission’s June 2018 report to Congress. MedPAC expressed concerns that stand-alone EDs in urban areas resulted in […]

Dive Brief:​ Spending on vendor-provided federal health IT goods and services is estimated to increase from $6.1 billion this year to $8.1 billion in 2023, according to a Health IT News summary of a market outlook report. That increase will largely be driven by EHR projects at the Department of Defense and Veterans Affairs. Spending will top […]

Seniors often found out only when they got surprise bills for the services Medicare doesn’t cover for observation patients. Under a new federal law, hospitals across the country must now alert Medicare patients when they are getting observation care and why they were not admitted — even if they stay in the hospital a few […]

The Louisville-based Humana is expanding a value-based payment model into seven additional states, while the Medicare agency has yet to set a clear course for how to handle such models. Humana announced last week it would start offering its bundled payment model for hip and knee replacements under Medicare Advantage plans to members in Alabama, […]

The ICD-10-CM Tabular List of Diseases and Injuries 2018 Addenda provides insight to future diagnosis coding. Let’s review what is new, deleted, and revised in chapters 1-7. In future months, we will cover additional chapters. Chapter 1: Certain Infectious and Parasitic Diseases (A00-A09) Two codes are added under A04.7: A04.71 Enterocolitis due to Clostridium difficile, […]

When your reimbursement staff is working old accounts receivable while also trying to stay up-to-date with current billing and collection activity, they can quickly feel overwhelmed. While the high dollar claims always need to remain a priority, you also need to keep a watchful eye on aging claims to ensure that NOTHING is resolved past […]

The multiple procedure payment reduction (MPPR) means that if a healthcare provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure. The reason is explained in Chapter 1 of the National Correct Coding Initiative (NCCI) Policy Manual: Most medical and surgical […]

The one thing doctors should be doing is making sure their patients have their address correct with Medicare. The patient won’t get a new card if their address is not correct. This simple reminder could diminish ongoing problems for providers in the massive transition underway to distribute new Medicare ID numbers. Since its inception in […]

Get a jump on five new HCPCS Level II codes going into effect July 1,2018. All are Q codes and they help patients with opioid addiction, knee pain, cystic fibrosis, and hemophilia. Q9991         Injection, buprenorphine extended-release (Sublocade), less than or equal to 100 mg Q9992         Injection, buprenorphine extended-release (Sublocade), greater than 100 mg Sublocade is […]

There is nothing more frustrating to physicians than knowing a patient needs a certain diagnostic test or medication and having them not be able to get it because their health insurance company won’t cover it. All too often, many services require prior-authorization (PA). It wouldn’t be so bad if the insurance companies made the guidelines […]