Category: Blog

July 2024 OPPS Update

Comprehensive Overview of CMS July 2024 OPPS Update (CR13632)

The CMS Releases July 2024 OPPS Update (reference: CMS Change Request CR13632, MLN Matters number MM13632). Here’s a summary of key changes: New Coverage for COVID-19 Pre-Exposure Prophylaxis: Drug: PEMGARDA (pemivibart) – Code: Q0224 (Note: This code is not reimbursed under OPPS, but at a “reasonable cost”) Administration: Code: M0224 (Covered: Receives separate payment under […]
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Common coding mistakes and how AI is resolving them

The administrative burden of accurate coding is a major contributor to physician burnout, a problem even worse since the COVID pandemic. Studies consistently show it’s a leading cause of stress for doctors and staff. Incorrect coding, including medical coding mistakes, can have serious financial consequences for medical practices. Denial of claims, reduced reimbursements, and audits […]
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Why Healthcare Providers Need Medical Claim Clearinghouses

Medical claim clearinghouses enhance the efficiency of claim submissions for healthcare providers, thereby reducing costs and improving payment accuracy. Each year, healthcare payers and providers exchange billions of claims to finalize patient encounters, a number that continues to rise. As claim volumes increase annually (except for a dip in 2021 due to the COVID-19 pandemic), […]
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payment posting processes

Streamline Billing and Boost Revenue with Efficient Payment Posting

While revenue cycle management (RCM) involves many steps, payment posting processes often gets overlooked. Optimizing this process acts as the cornerstone for smoother billing, reducing administrative burdens, and uncovering new revenue streams. By providing a clear view of daily income, accurate payment posting helps practices proactively address errors that could otherwise complicate medical billing and […]
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HIPAA violations

How to prevent HIPAA violations in healthcare

HIPAA violations happen when a healthcare organization fails to follow the Health Insurance Portability and Accountability Act (HIPAA) rules. HIPAA is a law that protects patients’ privacy by setting standards for securing and sharing their medical information. There are different ways a HIPAA violation can occur, but they often involve a patient’s protected health information […]
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Benefits of Remote Patient Monitoring (RPM)

The COVID-19 pandemic highlighted the need for alternative healthcare delivery methods. Remote patient monitoring (RPM) emerged as a valuable complement to telehealth, allowing doctors to remotely monitor patients’ health data in real-time. How Remote patient monitoring Works RPM utilizes various devices to track vital signs like blood pressure, heart rate, and blood sugar. It can […]
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340B modifier

Updated Guidance for 340B Modifiers from CMS in 2024 and 2025

The Centers for Medicare and Medicaid Services (CMS) recently updated guidance on the use of 340B modifiers by Medicare providers and reimbursement providers for drugs Part B biologics and the 340B Drug Enforcement Program. Published participation. The purpose of this rulemaking is to inform all provider types about the newly amended 340B requirements for 2024 […]
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TEAM: CMS’s New Value-Based Payment for Surgeries

The Centers for Medicare & Medicaid Services (CMS) is introducing a new way to pay for specific surgical procedures: Transforming Episode Accountability Model (TEAM). This mandatory model, starting January 1, 2026, will hold hospitals accountable for the cost and quality of care for 30 days after five types of surgeries: Lower extremity joint replacement Surgical […]
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Top Strategies to Prevent Medical Billing and Coding Errors

Medical coding and billing errors are a persistent headache for healthcare providers, costing them time, money, and reputation. Studies show that a staggering percentage of medical bills contain errors, leading to denied claims, delayed payments, and frustrated patients. Focus on Prevention: Top coding and billing Errors to Avoid Non-Covered Charges: Verify insurance coverage before rendering […]
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