Tag: Reimbursement

Append Surgical Modifiers With Confidence

Know how to differentiate modifiers 58, 78, and 79 to ensure proper reimbursement for all procedures performed. Modifiers convey important information about a claim and can directly affect reimbursement. But choosing the most appropriate modifier can be confusing — especially when two or more modifiers have similar descriptors. Modifiers 58, 78, and 79 are all used […]
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Denials Management Versus Denials Avoidance: CDI Can Capitalize

Typical CDI programs are intended to drive reimbursement through diagnosis securement, contributing to improved case mix index. The COVID-19 pandemic is placing monumental financial stressors upon hospitals, with added costs to treat patients with high acuity and long length of stays, coupled with significant revenue loss associated with postponement of more profitable elective surgeries, like […]
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How AI is Solving Big Challenges During COVID-19

Artificial intelligence is changing the way we think about healthcare during the COVID-19 pandemic, opening our eyes to new opportunities to use machine learning to draw useful conclusions faster. Before COVID-19, one of the biggest challenges healthcare organizations faced was how to accelerate and scale their application of AI—clinically and operationally. Now, the use cases […]
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6 Action Items for Your Denials Management Plan

There’s so much noise around denials management that it can be hard for even the most seasoned revenue cycle executives to cut through the clutter, find clear solutions, and make a solid plan. But that’s exactly what Kimberly Scaccia, vice president of revenue cycle at Mercyhealth in Wisconsin and Illinois, helped listeners do last month during a HealthLeaders webinar sponsored by Change […]
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Transforming Revenue Cycle Management Using Automation

In today’s healthcare industry today, there is a lot of buzz and hype surrounding automation. Large healthcare networks, medical facilities, and revenue cycle management service providers alike are looking to achieve a more efficient, robust revenue cycle through automation technologies. Any technology that can free employees to focus on high-value tasks and make revenue cycle […]
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Chronic Care Management Code Use Increases, But Uptake Still Lagging

Providers are increasingly using chronic care management (CCM) codes to address care fragmentation issues for patients with multiple chronic conditions. However, utilization patterns among providers could indicate some unaddressed challenges, according to a new study. The study recently published in the American Academy of Family Physicians examined publicly available Medicare data from 2015 to 2018. The data captured all […]
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A View into Proposed Medicare PFS and Policy Changes for 2021

The Centers for Medicare & Medicaid Services (CMS) in the past week has proposed Medicare payment rules for outpatient services and physicians for 2021 and finalized payment rules for inpatient rehabilitation facilities (IRFs) and psychiatric facilities. Looking specifically at the 2021 Physician Fee Schedule (PFS) proposed rule, scheduled to be published Aug. 17, it had […]
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CMS Announces New Payment Allocation for COVID-19 Patient Counseling

CMS will leverage existing evaluation and management (E&M) payment codes to reimburse eligible providers for the coronavirus counseling services.  The Centers for Medicare & Medicaid Services (CMS) will make payment available to physicians and providers for counseling patients at the time of COVID-19 testing about the importance of self-isolation after they are tested and prior to the […]
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Remote Patient Monitoring Update: Developments and Opportunities for Physicians

Heading into 2020, adoption of telehealth services was already on the rise. Then the health crisis hit. Now it appears that COVID-19 has not only cemented telehealth’s place in the healthcare landscape but done so in a very big way. McKinsey & Co. is projecting that virtual visits could potentially account for $250 billion, or 20%, of […]
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