Tired of the denial merry-go-round with payers? Is your staff tearing their hair out, along with you? In today’s healthcare landscape, receiving a denied claim can be tricky business if you don’t understand how to appeal a claim. To appeal a denied claim, one must first understand the type of
Struggling with prior authorization denials? Check these quick improvement tips! 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 »
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
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 »
On January 17th, 2024, The Centers for Medicare & Medicaid (CMS), put forth the final rule for CMS Interoperability and Prior Authorization for payers and providers (CMS-0057-F). The final rule goes into effect as of 2026. The purpose of the final rule is to reduce patient, provider, and payer burdens
NAVIGATING THE PRIOR AUTHORIZATION CONUNDRUM Read More »
