The key elements of emergency documentation that protect claims from medical necessity denials are the reason the patient sought emergency care, including how symptoms progressed, whether the patient arrived by EMS and what care was given before arrival, comorbid conditions linked to the presenting illness, the physician’s clinical reasoning and differential diagnosis, any referral from […]
Recently Healthcare Financial Management Association (HFMA) conducted a survey on day-to-day challenges faced by small practice owners. This survey revealed that frontline healthcare workers are not the only ones facing staffing shortages. Registrars, billing specialists, and patient follow-up staff were the most in-demand revenue cycle management positions. The survey gathered responses from more than 400 […]
Unique Medical Billing Operations in the Year 2022 With a considerable number of claims being denied, most medical practices have struggled during the COVID-19 pandemic. Recently, Apollo Healthcare has published its finding on how physicians are coping with the unique challenges of the COVID-19 pandemic. According to the ‘2022 Apollo Healthcare Predictions Report’, US doctors […]
During the Public Health Emergency (PHE), The Centers for Medicare & Medicaid Services (CMS) used a combination of emergency waivers, regulations, and sub-regulatory guidance to offer healthcare providers the flexibility needed to respond to the pandemic. In certain cases, these flexibilities suspended requirements in order to address acute and extraordinary circumstances. Now, CMS is taking […]
The SNF QRP creates SNF quality reporting requirements, as mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). On April 11, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare payment policies and rates for skilled nursing facilities (SNF) for the year 2023. This […]
Medicare, Medicaid, and private payers had relaxed their billing guidelines and revised reimbursement policies so that physicians can provide better care during the COVID-19 pandemic. A Public Health Emergency (PHE) was declared for the same by the federal government. In March 2020, a public health emergency (PHE) declaration was issued under Section 201 of the […]
Most practices are struggling to stay afloat due to shrinking reimbursements and the recent impact of the COVID-19 pandemic. The days of submitting an insurance claim and getting paid within 30 days are long gone. Various payer billing guidelines and reimbursement policies after the end of the Public Health Emergency (PHE) make it really difficult […]
Billing for continuous glucose monitor (CGM) services uses two CPT codes: 95250 for the technical component and 95251 for analysis and interpretation, each requiring at least 72 hours of monitoring and billable once per month per patient. On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) published a final rule which was […]
Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit. In order for a beneficiary’s DME to be eligible for reimbursement, the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination (LCD) must be met. In addition, there are specific statutory payment […]
On 7th April 2022, in response to the COVID-19 PHE and under section 1135 of the Social Security Act, CMS passed several temporary emergency declaration blanket waivers which were intended to provide health care providers with extra flexibilities required to respond to the COVID-19 pandemic. While the waivers of regulatory requirements have provided flexibility in […]
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