In light of new value-based care models and creative partnerships between providers, CMS is ditching its pay-and-chase approach to reducing Medicare fraud, waste, and abuse and implementing a new five-pillar approach based on prevention and technology. In a new CMS blogpost, the agency’s administrator Seema Verma detailed the new approach to reducing Medicare fraud, waste, and abuse, which includes:

In an effort to help broaden the ways in which social determinants of health can inform clinical decision making, eHealth Initiative & Foundation has recently released some new tools to promote the use of ICD-10-CM codes to capture SDOH data in the electronic health record.

Most healthcare organizations partner with physician services groups for niche coverage. While outsourced medical services are available across all specialties, common areas for external physician support include anesthesia, radiology, wound care, and emergency medicine. However, when outsourced physician services are used, challenges..

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.