Tag: CMS

CMS Releases Physician Fee Schedule Final Rule

CMS Releases Physician Fee Schedule Final Rule

  CMS says it the goal is to support health equity while focusing on high-quality person-centered care. Increased leverage of telehealth for behavioral care, diabetes prevention and mitigation, and enhanced payment for vaccine administration were three out of many priorities cited by federal officials who announced the release of the Centers for Medicare & Medicaid […]
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The Role of Provider-Sponsored Health Plans in Value-Based Care

The Role of Provider-Sponsored Health Plans in Value-Based Care

Provider-sponsored health plans can be naturally aligned with value-based care goals while also being attuned to providers’ needs. Providence Health Assurance’s Medicare Advantage provider-sponsored health plan received a five-star rating through the CMS Medicare Advantage Star Ratings system for the 2022 Medicare open enrollment season. The health plan, which serves Oregon and Washington State, is […]
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No Surprises Act Notice Requirements: The Good and Bad News for Providers

No Surprises Act Notice Requirements: The Good and Bad News for Providers

Surprise billing occurs when patients receive care from out-of-network providers without their knowledge. On July 1, the Biden Administration passed an interim final rule: the first portion of the “Requirements Related to the Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule […]
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The Changing Landscape of Healthcare B2B Payment Transactions

The Changing Landscape of Healthcare B2B Payment Transactions

Healthcare B2B payment transactions have been high in 2021, potentially signaling the importance of electronic payment transfers as the nation emerges from the coronavirus pandemic, according to a report from National Automated Clearing House Association (NACHA). Nacha oversees the ACH Network, a national payment system. B2B payments made through this network in the healthcare industry […]
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Gain Insight Into Billing an E/M With OMT

Gain Insight Into Billing an E/M With OMT

Reducing denials starts with understanding osteopathic manipulation as well as coding and coverage guidelines for this therapy. Is it appropriate to bill an evaluation and management (E/M) service when osteopathic manipulative treatment (OMT) is performed at the same visit? We must address a few key principles to adequately answer this question. I learned quickly, having […]
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Leaked CMS Report Targets Medicare Noncompliance at CA Hospital

Leaked CMS Report Targets Medicare Noncompliance at CA Hospital

A leaked CMS report targeting HCA Healthcare-owned Good Samaritan Hospital in California warns the hospital to fix Medicare noncompliance issues or risk termination. A leaked CMS report put HCA Healthcare-owned Good Samaritan Hospital in California at risk of program termination by October if they fail to fix Medicare noncompliance issues that resulted in patient harm. […]
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5 Things rev cycle leaders need to know about surprise billing interim final rule

5 Things rev cycle leaders need to know about surprise billing interim final rule

  Understanding the qualifying payment amount and the initial information on the independent dispute resolution process “should be a short-term priority for revenue cycle leaders and their teams,” says attorney Harvey Rochman. Earlier this month, the federal government released an interim final rule outlining certain provisions of the No Surprises Act (NSA), which is designed […]
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2021 E_M Guidelines FAQ

2021 E/M Guidelines FAQ

AAPC’s senior VP of products answers your questions about coding for office and other outpatient services. Ever since the release of the new 2021 evaluation and management (E/M) guidelines for office and other outpatient services, AAPC has been conducting numerous trainings through webinars, virtual workshops, conference sessions, online courses, and multiple articles in Healthcare Business […]
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