Healthcare News

On November 12, 2021, the CMS has announced a notable and rapid increase in Medicare premiums for the calendar year 2022. This 14.5% spike in Medicare Part B premiums will enlarge monthly premium payments for those in the lowest income bracket from a current $148.50 to $170.10 in 2022. This wil...

Claim denials are always frustrating. A large portion of underpayments occurs because of improper claim processing by insurance payers. However, in some cases, denials may as a result of a provider being non-compliant with a payer’s coding policy, or even with the one established by the CMS. N...

Recently some healthcare providers have reported having a negative balance with certain several insurance carriers they are participating with. Having a negative balance leads to a significant disruption in insurance payments, but it is not the end of the world. There are several ways of "fixing...

Claim timely filing limit is a specific period during which a provider may submit an insurance claim for the rendered services to the payer. In most cases, this period is defined by the number of calendar days since the date when a procedure has been performed. Should a claim be submitted outside of...

Pursuant to regulation by the US Department of Health and Human Services (HHS) on COVID-19 testing cost-share waivers issued on March 13th, 2020, outpatient healthcare providers are required to indicate a cost-share waiver in their claims for services performed on Medicare Part B patients.Namely, th...

Starting from November 1st, 2021, NYSDOH has increased fees for PDN services for eligible beneficiaries aged 23 or older. This increase is temporary and is planned to be waived on March 31st, 2022. The following services are affected:S9123 - Nursing care, in the home by a registered nurse, per ...

Following a recent FDA approval of the Pfizer-BioNTech COVID-19 vaccine for children 5 through 11 years of age, the CMS has determined that it is now covered for eligible individuals. Namely, individuals insured under Medicare, Medicaid, the Children's Health Insurance Program, as well as under...

The NY State Workers' Compensation Board has ruled out that effective July 1st, 2022, providers would need to use the CMS-1500 claim form for medical bills submission. This decision has been made to simplify this process and relieve providers from a significant portion of the paperwork. ...

Centers for Medicare & Medicaid Services has recently released an updated version of the ICD-10-CM for the fiscal year 2022. An updated set of diagnosis codes came to an effect on October 1st, 2021.The current edition includes 159 additions, 25 deletions, as well as 27 revisions. Here ...

Centers for Medicare & Medicaid Services has recently released an updated version of the ICD-10-CM for the fiscal year 2022. An updated set of diagnosis codes came to an effect on October 1st, 2021.The current edition includes 159 additions, 25 deletions, as well as 27 revisions. Here ...

CBR stands for Comparative Billing Report. Medicare CBRs are sent to healthcare providers whose billing or prescribing pattern differs from their peers within the same specialty state- and nationwide. Such reports are aimed at notifying and educating healthcare providers of significant divergence. F...

CMS is determined to lessen the administrative burden associated with participating in the Merit-based Incentive Payment System (MIPS) so that healthcare providers can focus on ensuring patients get the best quality of care. Thus, the following changes were made for next year an...

CMS has released a set of toolkits for providers, states, and insurers to help the health care system get ready to swiftly administer the COVID-19 vaccines and certain monoclonal antibodies once they become available. The resources are designed to increase the number of providers tha...

Medicare issued a waiver for telehealth services for the public health emergency. But which services are allowed, and who are permitted to furnish them? Keep reading to find answers to these and many more questions!   Question: What services can be offered via tele...

CMS has finalized changes to outdated federal regulations, such as the Stark Law, which have saddled health care providers with more administrative costs and impeded the advancement of the health care system toward value-based reimbursement. To know more about these changes and Anti-Kick...