Health plans and other stakeholders are convinced that the use of ICD-10 coding can greatly launch the uniform capture of data related to social determinants of health and improve health outcomes.

In an October 10 webinar hosted by the eHealth Initiative, Jennifer Bordenick, eHi’s CEO, called SDOH a “critical issue today.” That’s why eHi, the American...

More than 700 pages of text make up proposed changes to the federal Stark and anti-kickback statutes. On Wednesday, Oct. 9, federal healthcare officials announced two new proposed rules. While the main focus of both proposals is to remove perceived legal barriers to various value-based reimbursement models and facilitate care coordination, the changes have...

I shouldn’t be surprised. I have been reviewing denials by insurance companies since the late 1980s. I’ve seen the same things over and over again, such as slow pay, delayed pay, or no pay. They all relate to what legal experts describe as “bad faith.” Some examples of this are the following:

Medical coders are typically behind the scenes of patient care, analyzing records, selecting codes for billing, and managing patient data. But to Jannifer Owens, a revenue cycle expert with over 20 years of coding experience at small and large hospitals, coders are storytellers and their stories are crucial to hospital billing and quality compliance.

PR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from Deborah Marsh, senior content specialist for AAPC, a training and credentialing association for the business side of health care.

A “bold proposal” to reduce the documentation burden on physicians was released as part of CMS’s 2019 proposed Medicare Physician Fee Schedule (PFS). This seemed to have begun as an effort to listen to stakeholders and address the problems of out-of-date guidelines, cloning...

AI presents an entirely new landscape for defense against audits. The Trump administration has launched a program to employ artificial intelligence (AI) in Medicare audits. Use of AI will make obsolete current legal strategies leveraged when defending providers.

Patients come to your office looking for answers to their pain or lack of function. It’s critical that a doctor doesn’t do what one of my clients admitted to recently…“X-raying the patient’s wallet.” Your patients both deserve and expect your best recommendations. If you provide...