Articles Tagged With: reimbursement
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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.
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Thoughts on the Future and Laws Governing APP Practice
Some are asking if state of emergency provisions that loosened or suspended pre-COVID-19 regulations will remain. One example is regulations that govern the scope of practice and supervision of advanced practice providers.
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HHS Distributing $175 Billion in CARES Act Provider Relief Fund
The Department of Health and Human Services is distributing $175 billion to hospitals and healthcare providers to compensate for their coronavirus response. Through the Provider Relief Funds, $50 billion is allocated proportional to providers’ share of 2018 net patient revenue.
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Massive Switch to Telehealth Is ‘Unparalleled Opportunity’ to Examine Ethics
The sudden and explosive growth of telehealth during COVID-19 demanded sorting out all kinds of logistics, reimbursement, and scheduling processes in short order. The frantic time frames to set it up did not exactly allow for careful ethical reflection.