Payer denials have become a focal point in healthcare over the past year and with good reason, both Medicare (CMS) and Commercial payers like United Healthcare (UHC) and Aetna have denied more claims in 2024 for a myriad of reasons. Over the past three years, there has been over a
MASTERING DENIALS MANAGEMENT Read More »
Every year the Centers for Medicare & Medicaid Services (CMS), rolls out a new proposal of cuts to the Medicare Physician Fee Schedule or (MPFS), and on July 10, 2024, CMS did just that, they rolled out a rather shocking reduction of 2.8% to the MPFS for January 1, 2025
CONSEQUENCES OF CUTTING MEDICARE PHYSICIAN REIMBURSEMENT IN 2025 Read More »
With the recent release of CMS’s 2023 Improper Payment Report came some interesting results, of note are where Primary Care and the state of Florida land on Error Rates. The report indicates that after a thorough review by CMs, Primary Care was at the top of the list for most
Coding and Documentation – What Primary Care and Florida Have in Common Read More »
Well, here we are at the beginning of the fourth quarter of 2024 and CMS has graced us with their annual as I call it “The Come to Jesus Report”, as it highlights ALL the Coding, Billing, Documentation errors, and Service Types, across all states. It is a good read,
In January of this year, CMS expanded the Two-Midnight Rule (TM), which requires that a patient be admitted as inpatient when the clinician determines the patient requires more extensive treatment and services will encompass more than Two Midnights, versus the “old days” of being held in observation status as an
THE 2024 TWO MIDNIGHT RULE AND WHY PAYERS ARE SO CONCERNED Read More »
Having worked in both the private practice sector, hospital sector and payer sector in healthcare, I have seen things from all sides for both patient and provider. I am a firm believer in Pre-Visits and having the provider “set up” ahead of the patient visit. When I worked in for
PRE-VISITS – WHAT EXACTLY ARE THEY AND WHAT IS THE BENEFIT? Read More »
Well, it’s been awhile since I have discussed Risk Adjustment (RA), and all things Hierarchical Condition Categories (HCC), nonetheless, I have been watching the headlines since COVID 19 has finally been declared over and watching what CMS, HHS and Medicare Advantage (MA), payers are considering to effect change in the
I don’t know about you, but over the past several years, especially in a Post Covid world, good help in the front and back office of a medical practice seems to have a shortage of qualified individuals and is a revolving door for many practices. Not only are turnover costs
REVENUE CYCLE SLUMP – TOP KPI’S FOR PRACTICE EXCELLENCE Read More »
Having worked with both Emergency Department (ED), Providers and Urgent Care Providers, there is a definite difference in approaches with patient assessment between the two specialties. I have found that many ED Providers often felt that close to every case was a Level 5, or in fact, Critical Care (CC),
MDM UPDATES AND MORE FOR URGENT CARE 2024 Read More »
Well, here we are into the third quarter of 2024 and by now, if you’re a provider in private practice, you (and any other providers that may be working for you/with you), should have performed an Annual Wellness Visit (AWV), on most, if not all your active patients and hopefully,
BREAKING DOWN THE SDOH AND HOW IT APPLIES TO THE ANNUAL WELLNESS VISIT IN 2024 Read More »
