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The Medicare Outpatient Prospective Payment System (OPPS) final rule for calendar year (CY) 2021 continues cuts to hospitals in the 340B Drug Pricing Program and off-campus provider-based departments (PBDs), and updates the overall hospital star ratings methodology, effective Jan. 1, 2021. Payment Update CMS will increase base payment rates under the OPPS by 2.4 percent […]
CMS Rule Building on the CMS Interoperability and Patient Access final rule (CMS-9115-F), this proposed rule would place new requirements on Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs, and Qualified Health Plans (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of health care data, and streamline […]
Provider credentialing is the one of the important administrative process which contribute significant in to the quality of medical care. It also plays an important role in providers revenue cycle management to reimburse the deserving amount from payers. Without credentialing, providers cannot perform credentialing verification effectively and efficiently. This is the reason, providers are willing […]
The COVID-19 pandemic has changed how physicians provide patient care in the outpatient setting rapidly and dramatically. During this Public Health Emergency, continuity of treatment of existing patients as well as maintaining a professional relationship with new patients has become difficult. To prevent COVID-19 exposure threats, many geographic areas are under “stay at home” or […]
Deciding whether or not outsourcing medical billing is the right thing to do for your practice can be a difficult decision. Outsourcing is no longer a new technique for the world of medical billing. Outsourcing is now as mainstream as you can get. For medical practices, it turns out that outsourcing medical billing can be […]
Medicare can pay a strong net financial gain to a chiropractor who is certified as a supplier of Durable Medical Equipment (DME) under Medicare. At this time, the reimbursement levels are very good. Many chiropractors are not aware that these supplies are already obtained by their patients from other sources. For a long time, medical […]
The prevalence of surprise billing and out-of-network charges for ambulance rides and ambulatory surgery center (ASC) visits was examined by a couple of studies. ASCs, which provide same-day surgical treatment and medical procedures, have grown in popularity due to perceived lower costs than conventional hospitals for procedures such as colonoscopies and other gastrointestinal procedures, cataract […]
In a recent round of demands it has initiated, the HHS Office of Inspector General is targeting ambulance transportation services even as services continue to struggle financially during the pandemic. OIG is now seeking financial damages from ambulance services that may have transported patients during a Part A stay from a qualified nursing facility. Legal […]
What is the credentialing process for healthcare providers? Provider credentialing is the process of establishing that medical providers have proper qualifications to perform their jobs. This requires contacting a range of organizations, including medical schools, licensing boards, and other entities, to verify that the providers have the correct licenses and certificates. What are credentialing services? […]
Targeted Medicaid growth, boosting state contributions to Affordable Care Act marketplace grants, or a hybrid of these options may help rise payer coverage affordability. Healthcare coverage is far away out of reach for many low-income Americans due to healthcare cost. But 3 innovative solutions for Connecticut might shed light on how to boost payer coverage […]