HEALTHCARE NEWS

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...

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...

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...

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...

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...

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...

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...

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...

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’...

 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...

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.
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 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 ...

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 ...

 CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing.  Several Medicare legislative provisions affecting health care providers and beneficiaries recently expired, including exceptions to the outpat...

Beneficiaries who use covered Part A services may be subject to deductible and coinsurance requirements. A beneficiary is responsible for an inpatient hospital deductible amount, which is deducted from the amount payable by the Medicare program to the hospital, for inpatient hospital servi...