Category: Blog

New Rules from CMS

More New Rules from CMS for FY 2020

Among the proposed new rules is one intended to clarify the contentious “Stark Law” On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”). The law prohibits physicians from making referrals for […]
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Deciphering the CPT Code Changes

Deciphering the CPT Code Changes

The American Medical Association (AMA) publishes the Current Procedural Terminology code set changes every year, usually in September, for the upcoming new year. The changes impacting CPT 2020 were released on September 4, 2019. There was a total of 394 CPT code changes, of which, 58 affect the surgery center market. 2020 CPT Code Changes […]
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AI Can Help Health Plans Become Member-Centric

How AI Can Help Health Plans Become Member-Centric

Improving the customer experience is no longer an idea that’s relegated to the retail or hospitality industries. Now, the idea has gained traction across many industries, including healthcare. For health plans, improving the customer experience and providing member-centric care helps drive member acquisition and retention and improve reimbursement (via a better STARS rating). With so […]
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New CPT Codes for Self-Measured BP

New Year, New CPT Codes for Self-Measured BP

Guidance for using out-of-office BPs is not new. Medical evidence and clinical guidelines published over the last decade have showcased the importance of 24-hour ambulatory monitoring as the reference standard, and self-measured blood pressure monitoring (SMBP) as an acceptable alternative for obtaining BPs to diagnose and treat hypertension. And thanks to that abundance of research […]
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Artificial Intelligence (AI) Improve Clinician EHR

How Can Artificial Intelligence (AI) Improve Clinician EHR Use?

The implementation of artificial intelligence into healthcare is becoming more widespread by the day. EHRs may have worked to improve data use among medical providers, but these tools are still far from perfect. Digital medical records have introduced a host of problems, including disrupting clinician workflows, limited interoperability, and creating data overload. But with the […]
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CPT Updates

CPT Code Updates: Radiology, Emergency Medicine, and Behavioral Health Changes

Upcoming changes to the CPT code set include updates to radiology and medicine sections, effective for claims submitted on or after January 1. Radiology Updates Several radiology codes have been revised, added, or deleted: Revised Radiology Codes: 74022, 74210, 74220, 74230, 74240, 74246, 74250, 74270, 74280 New Radiology Codes: 74221 – Esophagus radiologic exam, double-contrast […]
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3 Issues Revenue Cycle Leaders Will Have To Battle

3 Issues Revenue Cycle Leaders Will Have To Battle In 2020

First hand experiences from the country’s most innovative revenue cycles will be shared next month in West Palm Beach, Florida. What issues keep revenue cycle executives up at night? As the HealthLeaders’ revenue cycle editor, I will moderate discussions and hear firsthand experiences of successes, challenges, and the latest ideas coming out of the country’s most innovative […]
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Preparing for ICD-11

HCC Coding: Preparing for ICD-11

HCCs thrive on specificity and ICD-11 will provide a higher level of specificity than in ICD-10. For those of you who are HCC coding for hierarchical condition category (HCC) purposes, you know that HCCs are categories of related ICD-10 codes. Only selected significant conditions to drive a payment HCC coding. That means only conditions that […]
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