Tag: Medical Billing Rules

Rules for Coding Emergency Department

CMS Rules for Coding Emergency Department Claims | Best Practices

The Centers for Medicare and Medicaid Services (CMS) has consistently authorized hospitals to establish and utilize their own coding guidelines for emergency department facility claims. CMS makes clear that “[a]s long as the services furnished are documented and medically necessary and the facility is following its own system, which reasonably relates the intensity of hospital […]
Learn More
Prior-Authorization Issue

Prior authorization issues with Medicare Advantage plans

A new final rule from the Centers for Medicare and Medicaid Services (CMS) will make it harder for Medicare Advantage (MA) plans to require prior authorizations for their coverage The rule comes in the wake of a 2022 report from the Office of Inspector General of the US Department of Health and Human Services that […]
Learn More
Administrative-Policies-Overburdening-Providers

Administrative Policies Are Overburdening Providers

Some commercial health insurers are using policies that can delay patient care and create burden for providers, causing relationships with hospitals to worsen, according to a survey by AHA. The association fielded responses from more than 200 hospitals in 2019 and from 772 hospitals between December 2021 and February 2022, creating data that both predates […]
Learn More

Time for Nonphysician provider E/M code change.

How do you feel you are handling the new American Medical Association (AMA) evaluation and management (E/M) guidelines? I know I’ve had to stop many times while auditing and make sure I was using the new criteria for office visits. I’ve even tried to use the new guidelines on hospital visits accidentally. I bet I’m […]
Learn More
x

Request a Free Quote