HEALTHCARE NEWS
Stay Informed: Latest Updates and Insights in Healthcare!
The Future of ACA Premium Subsidies
11/28/2024
The ACA Premium Subsidies: What’s at Stake in 2025? As the United States prepares for a potential change in administration in 2025, the future of the Affordable Care Act (ACA) premium subsidies hangs in the balance. Originally expanded during the COVID-19 pandemic under the Am...
Understanding the 2025 Policy Changes for CMS’s Quality Payment Program
11/22/2024
The Centers for Medicare & Medicaid Services (CMS) recently released the finalized Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) Rule, which outlines crucial updates and policy shifts for the Quality Payment Program (QPP) beginning with the 2025 performance year. Set to be publis...
The Hidden Challenges of Prior Authorization
10/29/2024
Providers are no strangers to the burden of prior authorization, a process requiring physicians to submit detailed paperwork to insurers for approval before administering treatments. Insurers claim this process helps prevent unnecessary medical interventions, saving the healthcare system from wastef...
New ICD-10-CM Codes: A Fresh Chapter for Rehab Therapists
10/11/2024
ICD-10-CM updates don’t often get much fanfare, but this year brings a notable shift for rehab therapists, especially those treating musculoskeletal issues. The longstanding challenges of coding for conditions like lumbar disc degeneration or synovitis—previously hindered by vague, unspe...
Systemic Barriers to Healthcare Access
10/2/2024
While the U.S. has made strides in reducing uninsurance rates, access to quality healthcare remains a complex challenge. We decided to explore the systemic barriers that hinder access to care, the crucial role of research in addressing these issues, and the potential of emerging trends to improve he...
UnitedHealthcare Gold Card Program
9/12/2024
To simplify the healthcare experience and reduce the administrative burden on healthcare providers, UnitedHealthcare is introducing a groundbreaking initiative: the National Gold Card program. Set to officially launch on October 1, 2024, this program represents a major step forward in modernizing th...
MIPS Reporting Countdown: Act Now to Avoid Penalties
1/9/2018
Merit Based Incentive Payment System (MIPS) eligible providers who fail to collect and report a minimum amount of 2017 performance data by March 31, 2018, could face a four percent negative payment adjustment on Medicare reimbursements in 2019 — with increasing penalties in the futur...
Evaluation and Management: Correct Coding Crucial for Compliance
7/20/2017
In a study report about how “Improper Payments for Evaluation and Management Services Cost Medicare Billions in 2010,” the Office of the Inspector General (OIG) noted 42 percent of claims for Evaluation and Management (E/M) services were incorrectly coded and 19 percent la...
Providers Must Report Enrollment Information Changes By Dictated Deadlines
6/28/2017
All providers must report enrollment information changes to their Medicare Administrative Contractor (MAC) within 30 days for a change in ownership, an adverse legal action, or a change in practice location, or 90 days for all other changes. Failure to do so could result in the revocation of your Me...
Humana’s $90 Million Settlement: Lessons for Healthcare Providers
8/22/2024
On August 16, 2024, Humana Inc. agreed to a $90 million settlement after a whistleblower lawsuit claimed the company overcharged Medicare for prescription drugs. Filed by former Humana actuary Steven Scott, the lawsuit exposed major issues within Medicare Part D and highlighted important takeaways f...
Leveraging Policy to Address Social Determinants of Health: A Strategy for Healthcare Reform
8/29/2024
Healthcare organizations have increasingly focused on addressing social determinants of health (SDOH) to improve patient outcomes and reduce healthcare costs. SDOH refers to non-medical factors like income, education, environment, employment, and social networks that heavily influence a person’...
Effective 4/1/2018, Universal Billing Codes for Home Care and Adult Day Health Care Services will be required!
3/1/2018
The New York State Public Health Law has been amended to require universal standards for coding of payment for home and community based long term care services claims. Specifically, it requires these codes to be based on universal billing codes approved by the Health Department and be con...
Do not wait until the last minute!
3/1/2018
Merit Based Incentive Payment System (MIPS) eligible providers who fail to collect and report a minimum amount of 2017 performance data by March 31, 2018, could face a four percent negative payment adjustment on Medicare reimbursements in 2019 — with increasing penalties in the future....
EmblemHealth Payment Reductions on Medicare Claims!
3/1/2018
In 2013, the Centers for Medicare & Medicaid Services (CMS) reduced premium payments to health plans, providers and suppliers by two percent as a result of cuts in federal spending. This reduction is known as sequestration.
EmblemHealth did not implement the reductions across the ...
New HIPAA guidance clarifies Sharing Information Related to Mental Health
2/1/2018
In the guidance, were addressed some of the more frequently asked questions about when it is appropriate under the Privacy Rule for a health care provider to share the protected health information of a patient who is being treated for a mental health condition.
The guidance clarifies when ...