Category: Healthcare News

CMS Proposes Changes to Physician Fee Schedule, Quality Payment Program

CMS Proposes Changes to Physician Fee Schedule, Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) is proposing changes to the Medicare Physician Fee Schedule (PFS) and the Quality Payment Program as part of its effort to reduce provider burden. “Clinicians are drowning in paperwork and reporting requirements caused by cumbersome government rules and regulations,” said CMS Administrator Seema Verma in a press […]
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Unpacking Proposed Merit-Based Incentive Payment System Changes

Unpacking Proposed Merit-Based Incentive Payment System Changes

CMS recently proposed Merit-Based Incentive Payment System changes in 2020 and beyond, including a new participation framework and higher performance thresholds. CMS is planning to overhaul reporting for the Merit-Based Incentive Payment System (MIPS) in order to make the pay-for-performance program less burdensome and more meaningful to providers, according a recently proposed rule. As reported last week, […]
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CMS Proposes Updates for OPPS, Pitches Price Transparency Rules

CMS Proposes Updates for OPPS, Pitches Price Transparency Rules

The agency dropped proposals for three key payment programs aimed at cutting administrative burden and boosting price transparency. CMS has released three new proposed payment programs that aim to reduce administrative burden, put patients over paperwork, and increase price transparency for patients, the agency said in a statement emailed to journalists. Specifically, CMS has proposed […]
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Artificial Intelligence in RCM

How AI Can Create A Massive Competitive Advantage – 4 Financial Applications

Healthcare organizations have a tremendous opportunity to harness artificial intelligence in an area that may not seem flashy but is important nonetheless: revenue cycle management. Although 94 percent of companies firmly believe AI can give healthcare organizations a “massive competitive advantage,” according to Change Healthcare’s Adam Sullivan, PhD, less than 5 percent have extensively incorporated […]
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Effective And Profitable Chronic Care Management

How To Deliver Effective And Profitable Chronic Care Management

Chronic care management (CCM) has an overarching clinical goal—improving the health of Medicare patients with multiple chronic conditions. Besides knowing the service parameters, pay rates and usage requirements for CCM codes, physicians must understand how to effectively bill for CCM in order to profitably achieve that goal. Medicare pays for CCM (typically, non-face-to-face) services to […]
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MEDPAC Calls For End To ‘Incident To’ Billing

MEDPAC Calls For End To ‘Incident To’ Billing

“Incident to” billing by advanced practice registered nurses (APRNs) and physician assistants (PAs) would be eliminated if Congress adopts a recent recommendation from the Medicare Payment Advisory Commission (MedPAC). In its June quarterly report to Congress, MedPAC suggests requiring APRNs and PAs to bill Medicare payment directly for all their services, rather than under the national provider identifier […]
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Medicare Advantage And The Future Of Value-Based Care

Medicare Advantage And The Future Of Value-Based Care

The Medicare Advantage (MA) program, which allows Medicare beneficiaries to voluntarily enroll in a private plan that administers health benefits, was established by the Balanced Budget Act (BBA) of 1997 as a vehicle to bring private-sector competition and innovation to Medicare beneficiaries. When the program was announced, the goal was to create greater competition on […]
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Using Artificial Intelligence To Advance Revenue Cycle Management

Using Artificial Intelligence To Advance Revenue Cycle Management

Artificial intelligence (AI) is making big waves in healthcare from detecting lung cancer and gene mutations that lead to autism to addressing social determinants of health and chronic conditions. The technology is automating and optimizing clinical workflows, leading to improved outcomes, lower costs, and enhanced patient and provider satisfaction. The critical role artificial intelligence now plays in healthcare prompting some providers to […]
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