Tag: Medical billing company

2023 Medicare Physician Fee Schedule on Unsustainable Cuts

2023 Medicare Physician Fee Schedule on Unsustainable Cuts

Lower Medicare payments to physicians will lead to patient care by reducing access to services, according to medical groups commenting on the 2023 Medicare Physician Fee Schedule (PFS). In July, the U.S. Centers for Medicare & Medicaid Services (CMS) announced the 2023 proposed rule and physician groups have been responding, including with detailed comments published […]
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More Versions to Come: No Surprises Act

More Versions to Come: No Surprises Act

Although the Biden Administration claims this is the final regulation, there is evidence more is yet to come. The Biden administration released the final No Surprises Act regulation recently but advised healthcare professionals that this final version is not the final one and promised more to come. The latest final rule was narrowly focused on […]
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New E/M Billing Guidelines for Unreimbursed Services

New E/M Billing Guidelines for Unreimbursed Services

Recent changes to evaluation and management (E/M) billing guidelines that allow physicians to bill for previously unreimbursed services are producing higher revenues for longer patient visits, according to results of a new study. The study in JAMA Network Open looks at the financial impact of CMS’s 2021 expansion of its time-based billing guidelines to include […]
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Value-Based Payment makes up 6.7% of Primary Care Revenue

Value-Based Payment makes up 6.7% of Primary Care Revenue

Value-based payment is severely lacking as a percentage of total medical revenue across practices as providers face scheduling and billing challenges. The transition to value-based payment is moving at a snail’s pace despite healthcare’s long journey with the transition away from fee-for-service, new survey data indicates. Value-based payment made up just 6.74 percent of total […]
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Flu Vaccination Coding and Billing for 2022-2023

Flu Vaccination Coding and Billing for 2022-2023

Has your billing department prepared for the upcoming 2022-2023 influenza season? As we approach the 2022-2023 influenza season, the Centers for Disease Control and Prevention (CDC) continues to recommend flu vaccination for everyone aged 6 months and older, with the ideal timing being by the end of October. This guidance remains consistent with previous years. […]
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Biden Administration Releases Final Surprise Billing Rules

Biden Administration Releases Final Surprise Billing Rules

The final surprise billing rules downgrade the weight the QPA has on out-of-network payment determinations and establishes documentation requirements for down coding situations. The Biden Administration has released final surprise billing rules implementing the No Surprises Act, a federal law enacted in January 2021 that protects patients from out-of-network medical bills when they seek care […]
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How to Get Paid: Coding Guide for 2022

How to Get Paid: Coding Guide for 2022

What you need to know to avoid claim denials and to maximize practice revenue Despite your best efforts to follow billing guidelines, payers still deny your claims. Or in some cases, they pay you and then take the money back. Experts say you can’t ever eliminate denials and post-payment recoupment entirely, but you can reduce […]
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5 Mid-Year Medicaid Expansion Updates

5 Mid-Year Medicaid Expansion Updates

Of the 12 states that have not expanded their Medicaid programs, four have taken legal, legislative, and/or budgetary actions this year with varying results. The Kaiser Family Foundation (KFF) has updated its state Medicaid expansion tracker, highlighting 2022 activity through July. The following summarizes activity in both expansion and non-expansion states. In January 2022, Georgia […]
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