Posted and filed under Coding, Medical Record Auditing, Payers.

Think Twice Before Appending Modifiers

Coding Modifiers In the English language, a modifier is used to describe the who, what, how, why, and/or where of a situation. Coding modifiers perform the same role for medical coders and billers. These types of modifiers further describe procedure codes without altering its original definition. Modifiers can be found in both the CPT and…

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Posted and filed under Business, Healthcare, Payers.

Value-Based Purchasing Still Perplexing Providers

Providers are still struggling to align with payers in the transition to value-based purchasing. Value-based purchasing is used to measure, report, and reward excellence in health care delivery. To properly incentivize high-quality care, value-based purchasing requires the cooperation of employer purchasers, public sector purchasers, health plans, and providers who are all tasked with assessing care…

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Posted and filed under Medical Record Auditing, Payers.

The Claims Denial Epidemic

The American Hospital Association recently released the results of a survey conducted to explore the efficacy of the RAC program in hospitals nationwide. The survey utilized the results responses submitted by 676 participating hospitals in order to explore the program’s impact in the second quarter of the year 2016. The results suggest that while Medicare…

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Posted and filed under Healthcare, Payers.

Payers Push for Stronger Prescription Cost Control

Over the years, healthcare costs have continued to skyrocket for consumers and providers alike. It is a well-known fact that the United States spends considerably more on healthcare costs than any other country in the world.  In fact, the United States spends 50 percent more than the next-highest spender-which is about $9,086 per U.S. citizen….

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Posted and filed under Payers.

CPC+, What’s all the Fuss?

Yesterday, CMS announced the next phase of their enterprising initiative to improve primary care. This nation-wide primary care model is the largest of its kind, and is known as the Comprehensive Primary Care Plus (CPC+), is a five-year primary care medical home model aimed to begin in January 2017. CPC+ plans on creating a culture…

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Posted and filed under Coding, FWA, Payers.

Vision vs. Medical Coverage Making You Bleary-Eyed?

Billing issues, to an extent, are expected in any physician or healthcare provider office. Most patients are in possession of both medical and vision benefits coverage, and this duality often causes confusion in ophthalmology offices. Certain procedures that are performed in an ophthalmology office should be billed as medical procedures, and do not apply to…

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Posted and filed under Compliance, Payers.
physician arms crossed

Quality Measuring Tools for Payers

How important is quality to you? For most people, quality – which equates to a measure of excellence and meeting strict standards – is one of the most important factors in most decision-making related to consumer goods and products. Take the automobile industry; businessdictionary.com uses the example that “if an automobile company finds a defect…

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