AMA: Payers not following prior authorization reforms they agreed to in 2018

Published: Wed, 07/20/22

AMA: Payers not following prior authorization reforms they agreed to in 2018

A new survey of physicians finds they are still facing burdens meeting prior authorization requirements despite a voluntary 2018 agreement among payer groups to reform the practice. The survey was released Tuesday by the AMA and comes amid criticism over prior authorization denials and requests in the Medicare Advantage space. The AMA spoke...

How Health Systems Improve Patient Collections

The rising cost of healthcare in the United States has left consumers feeling lost and overwhelmed. High deductible healthcare plans, co-pays, and out-of-pocket medical expenses have all contributed the emergence of healthcare consumerism, which is the pursuit of making healthcare services more efficient and cost-effective by putting the purchasing powering in the hands of the patient. Because of this...

AHA Comment Letter to CMS on the Provider Complaints Submission Process under the No Surprises Act

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — as well as the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) thanks you for the opportunity to comment on the forms providers may use to file complaints with the Centers for Medicare & Medicaid...

Myth or fact? You can’t bill E/M, preventive care from same visit

Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment.

CMS Releases 331 New PCS ICD-10 Codes

The Centers for Medicare & Medicaid Services (CMS) published the ICD-10-PCS codes and guidelines for the 2023 fiscal year on May 26, 2022. These inpatient procedure codes and guidelines will become effective Oct. 1, 2022.

Why You Should Be Using The Two-Midnight Rule

Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has become clear to me that many hospitals are systemically under coding, classifying patients who...

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