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 »
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 »
Whenever I am asked if an encounter qualifies for Incident To Billing, I always respond with “let me review the Medical Record first”. Generally, that is received with a few groans and some eyeball rolls, but it is a strongly suggested step in determining if the service provided is supported
AVOIDING INCIDENT WITH INCIDENT TO BILLING Read More »
From 2021 – 2024, What Have We Learned? It seems a lifetime ago, but it’s only been three years, since CMS, The AMA and CPT, made the first overhaul of the traditional 1995/1997, Evaluation and Management Guidelines, in what was supposed to be a new and easily understood mode of
