Articles Tagged With: reimbursement
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COVID-19-Specific Codes Can Maximize Reimbursement
As many hospitals continue managing COVID-19 patients, six new ICD-10 codes will help facilities obtain reimbursement.
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Controversial ‘Public Charge’ Rule Under Further Review
Scrutiny on DHS policy that targeted immigrants using government benefits such as Medicaid.
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Acupuncture as a Pain Management Alternative
The goal is to provide data that will convince payors to reimburse acupuncture treatment in the emergency environment, a stumbling block that has thus far prevented larger-scale implementation. Additionally, researchers hope their work leads to fewer unnecessary opioid prescriptions.
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CMS Finalizes 2021 Physician Fee Schedule, Tinged with a Bit of Controversy
A budget neutrality provision leads industry groups to cry foul over Medicare cuts.
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The Basic Elements of Healthcare Reimbursement, Part 2
This month will continue the discussion of healthcare reimbursement by third-party payers. We began last month with a review of the diagnosis-related groups (DRGs) and associated terminology. We will continue by reviewing how medical records are coded followed by the new MS-DRGs implemented in 2007.
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When Insurers Will Not Pay for Service Performed at a Hospital
It is not enough anymore to demonstrate that a surgery or imaging test is medically necessary. To receive reimbursement from health plans, patient access staff also must prove it is necessary for the procedure to happen at a hospital.
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The Basic Elements of Healthcare Reimbursement — Part 1
Changes in healthcare reimbursement have occurred with lightning speed over the last two decades. Providers billed for services rendered and were reimbursed — with no checks, balances, or control over costs of care. Case management, as a care delivery model, followed a similar course. But as reimbursement changed, so did case management. This month we will begin our discussion of reimbursement, including the changes to case management as it evolved with reimbursement.
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Telehealth Booming in EDs, but Poses Some Unique Liability Risks
EDs are using telehealth for screening visits before arrival or for follow-up re-evaluations on COVID-19-positive patients. It is important to know what can be excluded safely in a telemedicine consult, and what requires urgent and/or emergent in-person follow-up.
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Prosecutors May Look for COVID-Related Restructuring Fraud
Risk managers should be on the alert for fraud and abuse related to reimbursement issues and financial restructuring related to the COVID-19 pandemic. With the high reimbursement rates for a COVID-19 diagnosis for hospitals and an additional large sum for the use of a ventilator, the potential for fraud and abuse in hospitals is substantial.
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Take to Heart the Best Opportunities for ASCs
Two of the most desirable procedures for ambulatory surgery centers (ASCs) in 2020 and beyond are cardiology and vascular procedures, which the Centers for Medicare & Medicaid Services has just blessed for ASC reimbursement. Setting up a cardiac lab in an ASC requires some homework. They are not necessarily difficult or terribly expensive, but there are fine details worth understanding well.