The Centers for Medicare & Medicaid Services has sent its first wave of warning letters out to hospitals breaking federal rules requiring them to disclose payer-negotiated prices, a spokesperson for the agency confirmed. CMS has been auditing hospitals’ websites and complaint submissions since the rule went into effect on January 1 and began sending out […]
On April 27, 2021, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule for the fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS). The proposed rule includes CMS proposals for certain annual Medicare payment policies and rates as well as certain quality and value-based programs for FY 2022. Stakeholders must submit […]
Patient access is the first point of contact for patients and the first time staff can get key information right for revenue cycle management success. Patient access is generally the first encounter a patient will have with a healthcare organization, making it central to the patient experience. But this aspect of healthcare is also […]
At first glance, it appeared that hospitals were complying with the Centers for Medicare & Medicaid Services’ (CMS) price transparency requirement, which became effective January 1, 2021. Upon a closer look; however, multiple deficiencies were found. CMS previously advised that it would begin auditing compliance with the rule this past January. Interestingly, it was the […]
Our hospital has been denied CPT code 52601 because the operative report does not mention the word complete. Although the operative note described the procedure in detail and the pathology report showed benign prostatic hyperplasia (BPH) tissue, why do we need to state the word complete? What does it mean in the CPT description? CPT […]
The COVID-19 pandemic created a host of challenges for revenue cycle management leaders, from widespread service line shutdowns to shifting staff to work at home and increasing self-pay balances. These pressures have heightened inefficiencies in A/R processes and productivity. While these challenges took a massive financial toll on healthcare organizations—to the tune of $323 billion […]
Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2×4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)? A: The debridement would be reported using CPT code 11042 (debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less). This procedure […]
The healthcare sector is in urgent requirement of an AI solution that can process a massive amount of data without compromising the speed and accuracy of billing. Medical billing and coding is a critical component of healthcare. The medical billing outsourcing market alone is estimated to reach $16.9 billion by 2021. The coding and billing […]
Current issue includes most frequently asked questions about coding COVID-19. The American Hospital Association (AHA) central office is the official United States clearinghouse on medical coding for the proper use of the ICD-10-CM/PCS systems and Level I HCPCS (CPT-4 codes) for hospital providers – and certain Level II HCPCS codes for hospitals, physicians, and other health professionals. The […]
Being a physician comes with certain baseline stressors. For most, the culprits are pretty familiar: patient care responsibilities, high debt loads that compel long working hours, system complexities, and mounting administrative chores. COVID-19 has added yet another layer to the burdens that already contribute to physician burnout. As an emergency physician, walking into work every […]










