Tag: Medicare Reimbursement

Using-Modifier–25-on-an-EM-Visit

Using Modifier – 25 on an E/M Visit

In recent years, there has been an increase in scrutiny regarding the use of modifier -25 to identify separate evaluation and management (E/M) services on the same day as another procedure. Insurers are now demanding documentation of such services both before and after payment, leading to a significant administrative burden for urology practices. The reason […]
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3-Policies-Controlling-Physician-Reimbursements
  • March 29, 2023

The 3 Policies Controlling Physician Reimbursements

Three big CMS moves have affected physician reimbursements in the last 10 years, according to VMG Health’s 2023 mergers and acquisitions report released on March 21: Here are the three CMS policies: In April 2015, the Senate passed the Medicare Access and CHIP Reauthorization Act, which permanently removed the sustainable growth rate formula under the […]
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EM-Payment-Policy-Changes-Impact-Physician-Reimbursement

E/M Payment Policy Changes Impact Physician Reimbursement

Following E/M payment policy changes, the reimbursement gap between primary care and specialty physicians decreased by just $825, falling from $40,259.80 to $39,434.70. Evaluation and management (E/M) payment policy changes implemented in 2021 resulted in higher Medicare reimbursement for most physicians but only led to a modest decrease in the payment gap between primary care […]
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Need-for-Eligibility-Checks-for-Visits

Understanding the Need for Eligibility Checks for Visits

While these activities oftentimes become challenging, they should help in facilitating reimbursement. This month, we’ll dive into the next steps needed for medical practices to take after being credentialed to maximize the chances of receiving reimbursement. The next critical steps after getting credentialed are (1) to conduct eligibility checks for patient visits and (2) get […]
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Telehealth-Payment-Parity-Through-2023

Telehealth Payment Parity Only Good Through 2023

The omnibus spending bill continues telehealth waivers for two years past the PHE, but was silent on the issue of reimbursement. The federal government extended telehealth waivers for two years, but the current higher rate of reimbursement is in place only through the end of this year. During the public health emergency, the Centers for […]
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Expanded-Telehealth-Services-Won’t-Lower-Healthcare-Costs

Expanded Telehealth Services Won’t Lower Healthcare Costs

  Contrary to widespread hopes, the growth in telehealth brought on by the COVID-19 pandemic probably won’t lower health care costs. But it may make some services more widely accessible. A new Kaiser Family Foundation study compares average 2020 commercial insurance payments for evaluation and management and mental health therapy claims for services provided via […]
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Medicaid-Expansion-Boosts-Financial-Performance-of-Providers

Medicaid Expansion Boosts Financial Performance of Providers

Medicaid expansion improved financial performance for healthcare providers and was associated with lower uncompensated care costs and higher revenues. Medicaid expansion has positively impacted healthcare providers by boosting financial performance and resulting in payer mix improvements, data from the Kaiser Family Foundation (KFF) found. All but 11 states have expanded Medicaid eligibility as of January […]
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Medical-Billing-Outsourcing-Global-Market-Report-2023

Medical Billing Outsourcing Global Market Report 2023

Medical billing outsourcing services are services in which a healthcare provider hires a medical billing service provider outside their practice to do all the billing. The main types of services in medical billing outsourcing are the front end and back end. The front-end is in charge of the patient experience, while the back-end is in […]
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Guide-to-Coding-and-Documentation-Best-Practices

Guide to Coding and Documentation Best Practices

The difference between a financially and clinically successful practice and one that is struggling often comes down to whether they have the code right and document thoroughly. Changes in 2021 to major coding categories, such as evaluation and management (E/M) coding for office visits means major change that can hamper your operations if not done […]
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Successful-Alternative-Payment-Models-CMMI

The Successful Alternative Payment Models from CMMI, To Date

The Center for Medicare & Medicaid Innovation (CMMI) has launched more than 50 alternative payment and care delivery model tests, with 33 models now or still operational, according to CMMI’s sixth report to Congress on its progress. These model tests have impacted the lives of millions of patients. In the two-year period covering the report, […]
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