It’s common for people to feel surprised by the cost of hospital, medical imaging, or outpatient surgery bills. Unfortunately, it’s difficult for them to verify whether the bill is accurate or not. This is because incorrect medical bills have become increasingly common. To address this issue, organizations are turning to technologies such as artificial intelligence […]
According to a research letter published in top journal, the attempt by Centers for Medicare & Medicaid Services (CMS) to alleviate the EHR documentation burden on physicians has not yielded the anticipated outcomes. At the beginning of 2021, Centers for Medicare & Medicaid Services (CMS) revised the evaluation and management (E/M) coding requirements for outpatient […]
The relationship between medical coding and patient care may not initially appear connected, and they may even seem like complete opposites. While medical coding focuses on billing and revenue, patient care revolves around providing care to individuals. An from leading E-magazine’s recent article emphasized this distinction, asserting that prioritizing care is essential over coding. However, […]
With the healthcare sector generating vast volumes of data, leveraging data analytics can lead to improved patient outcomes, reduced costs, and enhanced operational efficiencies for Advantages of Data Analytics in Healthcare. Data analytics encompasses the collection, management, and analysis of extensive data to identify patterns, insights, and trends, enabling more informed decision-making. In the healthcare […]
In Congress this week, it wasn’t just pharmacy benefit managers facing scrutiny. The Senate’s Permanent Subcommittee on Investigations directed its attention towards Medicare Advantage (MA) plans, seeking explanations for claims denials. During the hearing, the committee’s chairman highlighted that letters were sent to the three largest MA plans—UnitedHealthcare, Humana, and Aetna—requesting documentation regarding their decision-making […]
Other progressive legislators from the House and Senate have brought back a Medicare for All bill. The proposed legislation aims to transition towards a single-payer health system by leveraging the existing federal program. Representatives, along with a coalition of 14 senators and 110 House members. The lawmakers are motivated by the devastating impact of the […]
Since the launch of OpenAI’s ChatGPT last year, healthcare executives have been actively discussing the potential of artificial intelligence in healthcare. The technology is constantly advancing, and health systems are closely monitoring its applications for maximum benefits. Microsoft is said to be working on a healthcare-oriented version of ChatGPT that prioritizes privacy, and they have […]
Despite ongoing concerns about denials and beneficiary access to care, Medicare Advantage (MA) companies remain in the spotlight as their market penetration continues to grow. In April 2022, a report from the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) highlighted a significant issue in the capitated payment model employed […]
The Children’s Health Insurance Program (CHIP) was established under the Balanced Budget Act of 1997 (BBA 97) to offer health insurance to children from low to moderate-income families who were ineligible for Medicaid but couldn’t afford private insurance. The program grants federal funding to states, enabling them to establish and enhance their own programs, and […]
In the intricate dance of healthcare administration, few steps are as frustrating and resource-intensive as denials management. Every rejected claim represents lost revenue, increased administrative burden, and potentially delayed or denied care for patients. In today’s challenging healthcare landscape, marked by shrinking margins and increasing regulatory complexities, a proactive and efficient approach to denials management […]









