Category: Blog

Claim Denial Rates as High as 80% for In-Network Services

Claim Denial Rates as High as 80% for In-Network Services

A new analysis shows that claim denial rates for in-network services among Healthcare.gov marketplace payers varied significantly, with some as high as 80%. Claim denial rates varied significantly among Healthcare.gov marketplace payers, with some insurers racking up rates as high as 80 percent, according to a new analysis from Kaiser Family Foundation. Marketplace payers must […]
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How to avoid medical necessity denials

How to avoid medical necessity denials

How to avoid medical necessity denials and ensure timely payment. Sick visit on the same day as an annual wellness visit (AWV) Reason for denial: Lack of clear clinical documentation regarding why the physician had to go above and beyond what is normally addressed during an AWV. How to avoid it:“I often tell doctors to […]
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Updates on End-Stage Renal Disease Prospective Payment

Updates on End-Stage Renal Disease Prospective Payment

CMS issued a proposed rule to update payment rates and policies under the End-Stage Renal Disease Prospective Payment System for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2023. Here are four takeaways from the proposed rule: Under the proposed rule, Medicare expects to pay $8.2 billion to approximately 7,800 facilities […]
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2022 care management services codes to know

2022 care management services codes to know

Question: Can you please tell us what the new codes are for principal care management and chronic care management? Answer: There are three new codes in the care management section of the CPT codebook. Care Management Services Principal Care Management Services New CPT codes have been added in 2022 to describe “Principal Care Management Services.” […]
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Why Medicare’s trustees say the physician pay system is unsustainable

Why Medicare’s trustees say the physician pay system is unsustainable

Medicare’s trustees have issued a report (PDF) that reckons with the consequences that patients could face as a result of the physician payment system’s long-term unsustainability. Your Powerful Ally The AMA helps physicians build a better future for medicine, advocating in the courts and on the Hill to remove obstacles to patient care and confront […]
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