Tag: Healthcare Policy

Value based payment

Value-Based Payment: Prioritizing Patient Health Over Profits

Value-Based Payment: Putting Patient Health First: When recommending a medical procedure, should doctors prioritize insurance reimbursements or patient health? The answer hinges on the payment model. In a fee-for-service system, providers are compensated for each individual service, potentially incentivizing excessive care. This model can lead to increased costs and harm patients through unnecessary treatments or medications. […]
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Prior Authorization Requirements

Physician Discovers Hidden prior authorization Details in CPT Codes

A proposal to track prior authorization using CPT codes was pulled back for revision after a surprising finding. An urologist, advocated for the plan to compensate physicians for time spent on prior authorization requirements. He also hoped it would streamline the process and improve patient care. However, the American Medical Association (AMA) informed urologist that […]
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The True Cost of Claim Denials in Healthcare

The True Cost of Claim Denials in Healthcare

According to a survey, claim denials are considered the biggest obstacle in revenue cycle management, with over 20% of providers reporting an annual loss of $500K due to these denials. A recent survey of healthcare leaders conducted by leading medical billing company revealed that claim denials are causing a significant and costly issue for healthcare […]
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3.36% Cut Threatens Medicare Physician Care Access in 2024

3.36% Cut in The Proposed 2024 Medicare Physician Pay Schedule

What’s the news: The AMA is emphatically stating that the proposed 3.36% reduction in the 2024 Medicare physician payment schedule is ill-advised, posing a threat to the accessibility of high-quality physician care for the 50 million plus elderly individuals enrolled in Medicare. The AMA President emphasized that with escalating costs associated with medical practice; another […]
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CMS-Proposes-Changes-to-RPM-in-2024-PFS-Proposed-Rule

CMS Proposes Changes to Remote Patient Monitoring in PFS Proposed Rule for 2024

The 2024 physician fee schedule (PFS) proposed rule has been released by the Centers for Medicare & Medicaid Services (CMS). Within this rule, remote physiologic monitoring (RPM), also known as remote patient monitoring, has garnered significant attention. While customary for a proposed rule, CMS has introduced several suggested modifications to RPM. However, what sets this […]
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Prior Authorization in Medicare Advantage

Prior Authorization in Medicare Advantage : Lawmakers Call for Streamlined Process

CMS has proposed a rule to simplify prior authorization in government-sponsored health insurance programs. However, some lawmakers are urging the agency to do more. A bipartisan coalition of 233 representatives and 61 senators have written a letter to CMS requesting that the proposed rules be expanded and that the changes be finalized quickly to enhance […]
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ICD-11 Is Coming, Prepare Now

IFHIMA makes the case for ICD-11 adoption with latest whitepaper. As healthcare transformation progresses due to the digitization of data and advancements in medical science and technology, it is increasingly important that nations around the world begin planning for adoption of ICD-11. The International Classification of Diseases (ICD) has a long and valued history of […]
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Industry Voices – 3 Challenges Exposed In The New World Of Telehealth

The rapid rise of telemedicine in response to the COVID-19 outbreak has been critical for getting at-risk patients the care they need. In fact, many state governments are working to expand telehealth within their Medicaid programs, while also easing restrictions to allow for faster implementation. And there is evidence that this trend will not be reversed anytime soon. […]
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