Tagged with Medicare Billing

Infographic – AdvantEdge Healthcare Solutions – Radiology

AdvantEdge Healthcare Solutions is one of the nation’s best radiology billing, coding, and revenue cycle management vendors for radiology practices across the country. To learn how AdvantEdge can be your  billing and coding vendor, call us at 877-501-1611 or email us info@ahsrcm.com    

Executive Order Issued to Protect Traditional Medicare and MA Plans

The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.

Data Mining Anesthesia Billing Data for Improved Practice Performance

By Joe Laden, Vice President of Client Management All billing companies and in-house billing operations provide a package of standard reports.   They are generally financial reports designed to report cash flow and illustrate the performance of the billing entity However, data collected for billing can provide a wealth of information for the practice beyond the…

Improper Payment for Intensity-Modulated Radiation Therapy Planning Services

In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity Modulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.

CMS Targeted Probe and Educate Audit Program

By Jeanne A. Gilreath, CHBME, Senior Vice President and Chief Compliance Officer One of the many programs CMS has implemented to help providers identify billing issues is the Targeted Probe and Educate (TPE) audit program.   It is designed to identify providers with high denial rates or unusual billing practices according to CMS.  If a provider is…

CAR T-Cell Cancer Therapy Available to Medicare Beneficiaries Nationwide

On August 7, CMS finalized the decision to cover Food and Drug Administration (FDA)-approved Chimeric Antigen Receptor T-cell (CAR T-cell) therapy, which is a form of cancer treatment that uses a patient’s own genetically-modified immune cells to fight disease. FDA-approved CAR T-cell therapies are approved to treat some people with specific types of cancer – certain types of non-Hodgkin lymphoma and B-cell precursor acute lymphoblastic leukemia.

CMS Expands Medicare Coverage of Ambulatory Blood Pressure Monitoring

CMS announced, on July 2, that it finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM), extending coverage of blood pressure monitoring devices to all Medicare beneficiaries suspected of reporting abnormal blood pressure levels when administered in clinical settings.

CMS Issues FAQs on BPCI Advanced Model

CMS, on June 21, issued several new or updated frequently asked questions documents on the Bundled Payments for Care Improvement (BPCI) Advanced Model, an Advanced Alternative Payment Model launched last October that will run through 2023.

Anthem Announces Fee Schedule Changes

Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.

CMS Looks at Revising HCAHPS Survey

In a notice to the Office of Management and Budget, CMS requested approval to collect public feedback on possible changes to the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS).

Supreme Court Rules Against HHS in DSH Payment Case

In a 7-1 decision, the Supreme Court ruled in favor of the nine hospitals that said the Department of Health and Human Services (HHS) violated the Medicare Act when it changed Medicare’s reimbursement adjustment formula for disproportionate share hospitals without providing notice and opportunity to comment.

CMS Finalizes Rule to Update and Modernize PACE

CMS has announced the release of a final rule designed to “update and modernize” the Programs of All-Inclusive Care for the Elderly (PACE) program, based upon best practices in caring for frail and elderly individuals.

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