Tag: CMS

Can-automation-solve-the-prior-authorization-problem

Can Automation Solve The Prior Authorization Problem?

In the latest American Medical Association (AMA) survey, 93% of physicians said prior authorizations delay patient care, and 82% said the process is so complicated that it causes patients to abandon treatment altogether. Prior authorization (PA) remains the top regulatory burden for most health care and medical professionals, often delaying or preventing access to essential […]
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EM-Payment-Policy-Changes-Impact-Physician-Reimbursement

E/M Payment Policy Changes Impact Physician Reimbursement

Following E/M payment policy changes, the reimbursement gap between primary care and specialty physicians decreased by just $825, falling from $40,259.80 to $39,434.70. Evaluation and management (E/M) payment policy changes implemented in 2021 resulted in higher Medicare reimbursement for most physicians but only led to a modest decrease in the payment gap between primary care […]
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Hospitals-Comply-with-the-Price-Transparency-Rule

Only a Few Hospitals Comply with the Price Transparency Rule

Over 1,500 hospitals reviewed in the report were noncompliant with at least one requirement of the price transparency rule between December 2022 and January 2023. Less than a quarter of hospitals are complying with the hospital price transparency rule over two years after the regulation went into effect, according to a report from PatientRightsAdvocate.org. The […]
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Check-Out-New-Codes-for-Reporting-Services

Check Out All the New Codes for Reporting Services

Don’t assume the codes you’ve been using to report drugs and biologicals still apply. The January 2023 update to the HCPCS Level II code file from the Centers for Medicare & Medicaid Services (CMS) includes 184 new codes for reporting services and supplies. Approximately 36 of the new codes were created to separately identify products […]
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Telehealth-Payment-Parity-Through-2023

Telehealth Payment Parity Only Good Through 2023

The omnibus spending bill continues telehealth waivers for two years past the PHE, but was silent on the issue of reimbursement. The federal government extended telehealth waivers for two years, but the current higher rate of reimbursement is in place only through the end of this year. During the public health emergency, the Centers for […]
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Ways-To-Handle-Patient-Collections

Ways To Handle Patient Collections

Collecting patients is not an easy job, but there are ways to handle it in an efficient and compassionate manner. We talk to experts on how to prevent payment delinquencies and how to handle them when they occur. Ways to prevent delinquencies Before physicians worry about collecting delinquent payments, there are several strategies to ensure […]
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Possible-Changes-in-Prior-Authorizations

A Surgeon General Touts Possible Changes in Prior Authorizations

Federal healthcare leaders say they are committed to helping physicians, patients, and health insurance companies by improving the prior authorization process for medical care. On Jan. 17, Center for Medicare & Medicaid Services Administrator and U.S. Surgeon General Vice Admiral, held a listening session with health care stakeholders. That was followed by a conference call […]
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New-Payment-Rates-Lead-to-Patient-Financial-Obligations

New Payment Rates Lead to Patient Financial Obligations

Happy New Year! 2023 has already started and as with every year, the new Medicare out-of-pocket rates take effect. And while the out-of-pocket costs for care should not affect how we care for our patients, it often comes up in conversations, so let us review the numbers. The Medicare Part A deductible goes up to […]
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Latest-Changes-in-the-CPT-Emergency-Department-Subsection

Latest Changes in the CPT® Emergency Department Subsection

Attendees at AAPC’s AUDITCON, Nov. 3-4, 2022, came loaded with questions about the coding and guideline changes for evaluation and management (E/M) services in CPT® 2023. The conference offered several sessions on the subject, including the ED session, “Changes in 2023: Emergency Department,” presented by AAPC Chief Product Officer. The officer provided a high-level overview […]
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Medical-Coding-Audits-Trends-and-Guide

Medical Coding Audits: Trends and Guide for Physicians

You’ve received a request for medical records from a payer, who is going to conduct an audit on your claims. Your Electronic Health Record (EHR) system is excellent, the notes are voluminous, your providers are well-versed at coding. If anything, you under code! You provide excellent care for your patients and achieve great outcomes. No […]
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