The Centers for Medicare & Medicaid Services (CMS) recently published the 2020 Medicare Physician Fee Schedule (MPFS) Proposed Rule. While many issues are included in the 1,700-page rule, three are of particular importance to pediatrics: e-visits, emergency department (ED) visits and office visits.

Denials are a source of frustration for all physicians. When left unmanaged, they’re also one reason why physicians ultimately sell or close their practices, says Dorothy Steed, CCS, CDIP, revenue cycle consultant in Atlanta. Here are six tips to improve the denial rate at your practice.

G71.01 is, literally, the code for Duchenne muscular dystrophy.  Q93.51 stands for Angelman syndrome, and G40.419 covers generalized and treatment-resistant epilepsies, which groups like Orphanet and the American Epilepsy Society define as including Dravet syndrome. All three designations are among some 70,000 other diseases listed in the...

Say goodbye to RUG-IV, and hello to the Patient-Driven Payment Model (PDPM). This is a daunting task, not for the faint of heart. Under PDPM, reimbursement for Medicare Part A patients in SNFs will be driven by patient condition, rather than by therapy minutes provided. Documentation is crucial to a successful Recovery Audit Contractor (RAC) audit.

Billing is essential to any business, but few must contend with the challenges associated with medical billing. Healthcare organizations are required to navigate a labyrinth of insurance payers, patient copays and regulatory requirements, which often leads to lengthy periods between services...

Hospital compliance programs have the potential to prevent costly denials and healthcare fraud investigations by conducting audits of high-risk areas, including coding, clinical documentation, and medical billing. Yet hospitals are still leaving millions of dollars on the exam room table.

Last week, the 11th Circuit (the federal appeals court for the Southeastern United States) issued a decision in the AsceraCare case. We have been waiting for this decision since the case was argued two and a half years ago. The key question in the case is: if a hospice provides care to a patient based on...

Physicians work hard to generate revenue, and with slim operating margins, they don’t want to contend with costly recoupments. Compliant coding and billing helps them avoid the focus of a pre- or post-payment audit. This article discusses four services that...