Category: Blog

Billing for Tetanus Vaccine? Check the Diagnosis

Billing for Tetanus Vaccine? Check the Diagnosis

Did you know that tetanus vaccines are covered under Medicare Part B only when administered for treatment purposes? Preventive tetanus vaccinations do not fall under coverage. The Centers for Medicare & Medicaid Services Internet-Only Manuals Pub. 100-02, Chapter 15, Section 50.4.4.2 clarifies, “Vaccinations or inoculations are excluded as immunizations unless they are directly related to […]
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No Surprises Act dispute resolution challenge

No Surprises Act dispute resolution challenge

The AHA and American Medical Association yesterday filed a friend-of-the-court brief in support of a Texas Medical Association lawsuit claiming the revised independent dispute resolution process for determining payment for out-of-network services under the No Surprises Act skews the arbitration results in commercial insurers’ favor in ways that violate the compromise Congress reached in the […]
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Hospitals Increased Recruitment and Retention Strategies

Hospitals Increased Recruitment and Retention Strategies

Hospitals are ramping up recruitment and retention strategies as they navigate ongoing workforce shortages and rising expenses. A majority of hospital leaders have increased starting salaries and introduced signing bonuses to attract new employees. The 2022 Healthcare Performance Improvement Report, based on responses from 86 hospital and health system leaders across the U.S., highlights the […]
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PBMs tend to Dominate State and Local Markets

PBMs tend to Dominate State and Local Markets

Pharmacy benefit managers (PBMs) tend to dominate state and local markets where they provide services to commercial health insurers across the United States. That could mean patients are stuck with higher prescription drug prices, according to new research published by the American Medical Association (AMA). The Policy Research Perspective report, “Competition in Commercial PBM Markets […]
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CMS Includes HCPCS Level II Code Changes

CMS Includes HCPCS Level II Code Changes

Dozens of additions, deletions, and revisions are effective Oct. 1, 2022. The October 2022 update to the HCPCS Level II code file from the Centers for Medicare & Medicaid Services (CMS) includes more than 40 changes, and most of them are new codes. The changes are effective Oct. 1, 2022, with a few important exceptions. […]
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10 Steps Will Help You Prevent Denials

10 Steps Will Help You Prevent Denials

Healthcare policies and rules are continuously changing, and it’s important to stay on top of what all insurance carriers are doing and how their changes impact your practice’s revenue cycle. This, as well as managing your accounts receivable (A/R), is the best way to ensure your cash flow does not bottleneck and cause damage to […]
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Intricacies of the 2021 E/M Coding Guidelines

Intricacies of the 2021 E/M Coding Guidelines

Industry experts explain the intricacies of the 2021 E/M coding guidelines. During the Evaluation and Management (E/M) Panel general session, an expert panel made up of a physician, coder, auditor, payer, and a representative from the American Medical Association (AMA) answered audience questions regarding the 2021 E/M coding guidelines for office/outpatient visits. The panelists were […]
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Value-Based Care Catching up to Fee-For-Service

Value-Based Care Catching up to Fee-For-Service

Outcomes-based models are spreading, but fee-for-service still dominates payment landscape. Is value-based care having a moment? Health care policy experts and institutions have long agreed that fee-for-service (FFS) medicine is wasteful, outmoded and at least partially responsible for the U.S. spending far more than peer nations on health care, but with outcomes that are no […]
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