Category: Blog

AMA Aims to Streamline Prior Authorization Billing with New Codes

AMA Aims to Streamline Prior Authorization Billing with New Codes

New billing codes: Medical experts might consider creating new billing codes for the time doctors and their support staff spends working on prior authorizations. The American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Board meets May 9-11 in Chicago. On the meeting’s agenda are three potential new CPT codes “for reporting services (physician, QHP, […]
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Medical billing and interoperability

Medical billing and interoperability

Interoperability role in medical billing: A growing number of physicians practice in an interconnected world, which means that medical practices and hospitals need to seamlessly share information in order to be able to provide good health management and ensure that patients are treated safely and effectively. Health care interoperability is an important concept that has […]
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Navigating Regulatory Compliance in Medical Coding for Accurate Billing

Navigating Regulatory Compliance in Medical Coding for Accurate Billing

Explore the intricacies of codes for a better understanding of regulatory compliance in medical coding. Healthcare billing and documentation are based on medical coding. An accurate representation of the patient’s health journey, appropriate reimbursements, and avoiding potential legal pitfalls are crucial to ensuring accurate representation of the patient’s health journey, not just an administrative formality. […]
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Advances in AI and Technology for Efficient Value-Based Care 2024

Advances in AI and Technology for Efficient Value-Based Care 2024

Value-based care in 2024: As 2024 approaches, healthcare is undergoing unprecedented innovation and digital transformation. Emerging technologies and capabilities are empowering organizations, including payers, providers, and self-funded employers, to confidently embrace risk within value-based care programs. The American Academy of Family Physicians reports that 49% of practices participate in some form of value-based payment, and […]
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Differences: Preventive vs. Office Visits in Medical Coding & Billing

Differences: Preventive vs. Office Visits in Medical Coding & Billing

Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is […]
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Congressional Concerns: Lawmakers Challenge CMS on NSA Implementation

Congressional Concerns: Lawmakers Challenge CMS on NSA Implementation

NSA Implementation Shortly before Congress adjourns for 2023; lawmakers sent another in a series of letters to the Centers for Medicare and Medicaid Services (CMS) expressing “serious concerns” about the implementation of the No Surprises Act (NSA). The letter accused CMS of failing to properly implement key portions of the law and suggested that the […]
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The Impact of CMS-0057-F on Streamlining Prior Authorization Processes

Interoperability & Prior Authorization Final Rule: Impact on US Healthcare

The healthcare landscape in the United States is poised for a significant transformation with the implementation of the Interoperability and Prior Authorization Final Rule (CMS-0057-F). This landmark rule, finalized by the Centers for Medicare & Medicaid Services (CMS) on January 17, 2024, directly tackles the often-cumbersome prior authorization process, aiming to alleviate administrative complexities for […]
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