HealthLeadersMedia.com - Managed Care Contracting and Reimbursement Advisor

Understand three-day DRG �payment window to improve reimbursement

Thu, 01 Mar 2012 05:00:00 GMT

CMS' rule for billing preadmission nondiagnostic services has long determined how physicians can bill for certain types of care, like presurgical lab tests, before a patient is admitted to a hospital, but now the requirements have been changed. The new rule broadens the requirement so that more outpatient procedures will have to be bundled with the inpatient billing.

5010 enforced this month, so take action now

Thu, 01 Mar 2012 05:00:00 GMT

Complying with the new 5010 HIPAA transaction standards could require practices to upgrade or even replace their current information systems and modify their existing coding practices. CMS will begin enforcing the requirements March 31, so if your transition isn't complete, you need to get to work now.

Improve patient billing experience to increase revenue

Thu, 01 Mar 2012 05:00:00 GMT

Patients today are overwhelmed by the complexity of medical bills. Physicians regret their patients' frustration, but they often don't realize how much it can impact a practice's revenue, says Joshua Greenberg, chair and president of Santa Monica (CA)-based HealthCPA, a company that helps both patients and physicians with healthcare billing management.

CMS adds coverage for services to reduce obesity

Thu, 01 Mar 2012 05:00:00 GMT

CMS announced recently that Medicare is adding coverage for preventive services to reduce obesity.

Legislation aims to ensure prompt payment for Medicaid providers

Thu, 01 Mar 2012 05:00:00 GMT

U.S. Reps. Brian Bilbray (CA) and Anna G. Eshoo (CA) introduced legislation recently to ensure that Medicaid providers are paid in an appropriate time frame.

Managed Care Contracting & Reimbursement Advisor, March 2012

Thu, 01 Mar 2012 05:00:00 GMT

Final Physician Payment Rule Factors in GPCI

Fri, 10 Feb 2012 12:00:00 GMT

The final 2012 Medicare physician payment rule from the Centers for Medicare & Medicaid Services includes an adjusted fee schedule for the Geographic Practice Cost Index. The adjustment prevents large cuts this year and will help California physicians in the future.

You have more leverage than you think when dealing with denials

Wed, 01 Feb 2012 05:00:00 GMT

Denials can wreck your revenue stream, but physician practices often give up on payment too soon, says Richard J. Quadrino, JD, founding partner with the law firm of Quadrino Schwartz in New York City. Many of your "dead" claims are payable if you know the law, he says.

Incident-to billing in OIG's sights this year

Wed, 01 Feb 2012 05:00:00 GMT

HHS has put physician practices on notice that it will be taking a close look at billing under Medicare's "incident-to" billing rules this year, so now is a good time to review how you use this option.

5010 deadline extended but MGMA, AMA say threats still exist

Wed, 01 Feb 2012 05:00:00 GMT

CMS' Office of E-Health Standards and Services (OESS) has announced a 90-day period of "enforcement discretion" for compliance with the new 5010 HIPAA transaction standards, but leading professional organizations say that is not enough.

Managed Care Contracting & Reimbursement Advisor, February 2012

Wed, 01 Feb 2012 05:00:00 GMT

ACO final rule removes many hurdles, makes option more appealing

Sun, 01 Jan 2012 05:00:00 GMT

Physicians and practice managers have been trying to decide for months now whether an accountable care organization (ACO) could be a viable path toward a more secure financial future, but there were plenty of reasons to be wary. The decision could be easier now that the final rule has been issued by HHS-many of the barriers were removed.

ACO antitrust fears addressed by FTC, DOJ

Sun, 01 Jan 2012 05:00:00 GMT

Any consideration of joining an accountable care organization (ACO) quickly leads to concerns about antitrust issues, but the Federal Trade Commission (FTC) and the Antitrust Division of the Department of Justice (DOJ) have issued a joint statement suggesting that physicians can participate with little fear of violating the law.

CMS announces primary care initiative, solicits participation from payers

Sun, 01 Jan 2012 05:00:00 GMT

CMS has announced plans to develop a Comprehensive Primary Care (CPC) initiative in which it is seeking participation of healthcare payers as its first step, with plans to develop a multi-payer model that focuses on making adjustments in the delivery of and payment for primary care services.

CMS proposes first real revision in Medicare CoP since 1986

Sun, 01 Jan 2012 05:00:00 GMT

CMS has proposed what would be the first significant revision in the Medicare Conditions of Participation (CoP) in 25 years.

RAC auditors find $92 million in Medicare overpayments

Sun, 01 Jan 2012 05:00:00 GMT

CMS recently released a report to Congress detailing how RACs found $92 million in improper Medicare payments during fiscal year (FY) 2010.

Managed Care Contracting & Reimbursement Advisor, January 2011

Sun, 01 Jan 2012 05:00:00 GMT

ICD-10 coming sooner than you think, will radically change reimbursement

Thu, 01 Dec 2011 05:00:00 GMT

The new ICD-10 medical coding system, which all medical practices, hospitals, and health plans around the country must adopt by October 1, 2013-unless it is delayed again-will shake up the entire revenue and reimbursement system for providers. Although 2013 sounds like a far-off deadline, physician practices should be well into preparing by now.

Concierge medicine could be the solution to falling �revenue, uncertainty

Thu, 01 Dec 2011 05:00:00 GMT

When it all becomes too much-the falling revenue, the long hours, the hassle of working with third-party payers, the uncertainty of what the healthcare system will look like five years from now-many physicians dream of getting out. But there is another option that might appeal to them.

Practice offers lessons learned from attesting to Stage 1 meaningful use

Thu, 01 Dec 2011 05:00:00 GMT

Diamantoni & Associates of Lancaster, PA, attested to Stage 1 of meaningful use recently, resulting in the five-office practice and 18-provider group receiving more than $300,000 in federal incentive payments. Along the way they learned a few lessons that might help other practices, says health information technology consultant Christine Kelly of CMK Consulting, who helped Diamantoni with its electronic medical record (EMR) implementation.