CMS OMH Marks Women’s Health Week with A Call to Action

Published: Wed, 05/22/24

Updated: Wed, 05/22/24

Link to all things medical coding & billing

CMS OMH Marks Women’s Health Week with A Call to Action

Federal officials are marking National Women’s Health Week with a call for awareness and reform to address stubborn disparities that have lingered historically – and to this day lead to poorer medical outcomes. The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) noted that the week-long event begins on Mother’s Day each year, followed by comprehensive efforts to...

Why private practices need a stronger handle on the revenue cycle

A physician private practice with a good handle on its revenue cycle can bring in more dollars and adapt more quickly to external forces such as lower payment rates. It can also increase patient satisfaction “because of different transparencies that you can pass on to your patients. Their bills and statements may be clearer if you review the revenue cycle and optimize it,” said Sea Chen, MD...

Understanding Billing Requirements for Caregiver Training Services

As part of the Jan. 1, 2024 Outpatient Prospective Payment System (OPPS) guidelines, caregiver training services (CTS) codes were listed as billable services if provided by physicians and non-physician practitioners (NPPs). I thought I would revisit these codes with greater specificity, as I am seeing some questions come up related to lack of provider...

Consideration postponed for new billing codes for prior authorization

Medical experts have put on hold a proposal to create new billing codes for prior authorizations. The American Medical Association’s CPT (current procedural terminology) Editorial Panel was scheduled to meet May 9 to 11. The agenda included a proposal to create new codes that physicians could use to bill for time spent requesting approval to treat patients.

Medicare Advantage risk assessments driving billions in costs each year

Medicare Advantage plans have come under fire for upcoding that can increase the payouts they receive, and regulators point to health risk assessments as a likely culprit in this increase in coding intensity. A new study published this week in Health Affairs adds to the body of evidence around these assessments. The analysis, led by researchers at Brown University, dug into encounter data from 2019 and found that...

Defenses Against Medicare Audits Based on Use of Artificial Intelligence (AI): Part III

Is there an arms race involving using technology for submitting claims and auditing them? In one example, an electronic health record system was deployed that would increase reimbursements. It would do this by inserting into patient charts default templates that allowed physicians and others to copy in information from patient records – assuming, of course, that...

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