As payers like Aetna, ANthem, Cigna, Humana, UHC, SelectHealth, Blue Cross/Blue Shield embrace telehealth and establish their own programs, major healthcare networks are also reaping benefits from the exploding technology. Large networks like Kaiser Pemanente, Geisinger, Cleveland Clinic, and UPMC Health Plan are incorporating telehealth not only for outpatients but for inpatients. In an article ...
When provider and payer work together, everyone wins. By Marcia A. Maar, COC, CPC, CRC Clean, accurate provider documentation improves reimbursement. To demonstrate, consider the ideal reimbursement process: A patient comes in for an office visit or service. A provider documents the reason for the visit, which proves medical necessity for services provided on the ...
Under the Medicare Physician Fee Schedule (PFS), certain services (such as surgery) are valued and paid for as part of global packages that include the procedure and the services typically furnished in the periods immediately before and after the procedure. For each of these global packages, the Centers for Medicare & Medicaid Services (CMS) establishes ...
In CMS
Aug 15th, 2016
The Centers for Medicare & Medicaid Service (CMS) established a a temporary provider enrollment moratoria July 29, to help fight fraud. This move was paired with a new, related demonstration project to allow for certain exceptions to the moratoria and heightened screening requirements for new providers.  CMS also announced it is immediately lifting the current temporary ...
Sep 30th, 2015
by Pamela J. Haney, MS, RHIA, COC, CIC, CCS ICD-10 is finally a reality. We have learned to code diagnoses with ICD-10-CM, mastered the root operations in ICD-10-PCS, and we are ready to put our new skills to work. Documentation challenges plagued us in ICD-9 but become more challenging with ICD-10 due to the increased ...