In the complex world of insurance and healthcare claims, the concept of “zero-paid claims” can feel like a phantom menace. You’ve submitted a claim, received an Explanation of Benefits (EOB) or remittance advice, and to your dismay, the payment is… zero. While a zero payment might seem innocuous, it can, in certain scenarios, be interpreted […]
The Centers for Medicare & Medicaid Services (CMS) has unveiled a series of Medicare payment rules that will dramatically impact Medicare payments for 2025. These changes encompass payment rates, coding guidelines, coverage criteria, and quality measures for various healthcare providers. Physicians, in particular, face a proposed average payment rate cut of 2.93% under the fee […]
Medicare Conversion factor are up but payouts are still down compared to last year. Healthcare professionals will see a slight upward adjustment to their Medicare payments starting March 9 after President Biden signs the Consolidated Appropriations Act (CAA), 2024. Really fortunately, although the 2024 CAA increases the conversion factor (CF) finalized for calendar year (CY) […]
The Senate Finance Committee proposed that the full chamber should review a legislation that could instigate alterations in physician practices. This proposition was discussed during a 90-minute meeting on November 8, 2023, regarding the bill named “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” This bill encompasses diverse aspects of healthcare, including mental […]
CMS released the fiscal year (FY) 2023 inpatient prospective payment system proposed rule with proposals for new calculations for FY 2023 rate setting. Although CMS is proposing to use FY 2021 data for FY 2023 Medicare Severity Diagnosis-Related Groups (MS-DRG) rate setting, the agency wants a modified methodology to account for the historical and potential […]
CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2023 (the Proposed Rule). In the Proposed Rule, CMS proposes to update the IPPS and LTCH payment rates, modify the payment rules for direct graduate medical education (DGME) to comply with a recent […]
Don’t send another RHC claim until you’ve reviewed these key changes for 2022. A Rural Health Clinic (RHC) is a clinic located in a rural, underserved area with a shortage of primary care providers, personal health services, or both. Medicare pays RHCs for the provision of certain primary care and preventive health services in […]
For most readers the results of this analysis will be amazing but true. Longtime RACmonitor contributor and R1 Physician Advisory Services Vice President Dr. Ronald Hirsch recently pointed site Publisher Chuck Buck in the direction of something that, frankly, wowed him: a PhD thesis from a young Columbia University student on the topic of […]
The Centers for Medicare & Medicaid Services (CMS) has finalized 2022 payments and policies under the Medicare Physician Fee Schedule (MPFS). The rule includes updates to payment rates for physicians and other healthcare professionals for calendar year (CY) 2022; expands the use of telehealth for mental health; clarifies policies related to split (shared) visits, critical […]
More than a third of Representatives call on the federal government to revise No Surprises Act implementation, specifically around the independent dispute resolution process. A bipartisan group of 152 House members wrote to the secretaries of Health and Human Services, Treasury and Labor and urged them to amend the interim final rule (IFR) that will […]










