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Practice Management

Everything You Need to Know About the CMS-HCC-V28 Changes and How AI Helps

A new year brings excitement, fresh starts, and the latest changes to the CMS-HCC (Centers for Medicare and Medicaid Services hierarchical condition category) risk adjustment model, version 28 (V28). And even if you're excited about 2024, the guideline updates are probably stressful and a bit deflating. It can take months for coding and revenue cycle teams to get up to speed with the latest updates, and the training and accompanying expenses – as well as the inevitable mistakes that come with any coding update – cause billing delays, underpayments, and claim denials. Most healthcare organizations likely still have last year's evaluation and management changes for emergency departments fresh on their minds. Will you experience the same struggles again with CMS-HCC-V28?

2023 brought about the mass adoption of AI. But even though AI has only recently moved into the mainstream, the technology has been used in healthcare for decades. According to Cedars-Sinai Medical Center in California, AI medical applications were first explored as far back as the 1970s. Today, the technology is used in everything from diagnosing patients to transcribing medical documents and even dealing with guideline updates. There are five ways AI can make transitioning to CMS-HCC-V28 more efficient. Before we get to those, let's look at some of the changes ahead.

What Are the Changes in CMS-HCC-V28?

The overall goal of the CMS-HCC changes is simple: Capture more accurate and complete data on chronically ill patients. Unfortunately, these changes are quite complex in practice. They impact how HCCs map, coefficient HCC values, and HCC code names and numbers. Diagnosis codes are also affected: The changes removed 2,294 codes that map to an HCC payment and added 268 previously unmapped ones.

Factor in specific updates to various condition categories, including heart disease, blood disease, and diabetes, among others, and you have an overwhelming number of changes that could slow down your revenue cycle team for months. Thankfully, AI can help.

Handle Guideline Changes With AI and Save Time, Mistakes, and Money

It might sound too good to be true, but AI can dramatically improve your transition to version 28 by increasing efficiency and guaranteeing that you receive proper reimbursement under the new model. Here are five ways it does just that.

1. Updates with the press of a button: What if implementing coding guideline changes was like updating your computer? All you had to do was click a few buttons, drink a hot cup of coffee, and wait for a few short hours for the changes to apply. The speed at which AI can implement guideline updates varies depending on the complexity of the changes and the technology itself. Still, the process is similar to updating a system's configuration, which means it's substantially easier, faster, and cheaper.

2. Trains and collaborates with coders: Just because AI can accelerate the transition to new guidelines doesn't mean you can eliminate human coders or forgo training. In fact, AI can play a critical role in training your staff and speeding up the process, thus reducing costs. How does it work? While your team codes, AI provides real-time guidance and feedback based on the new update rules. And the system works both ways: coders can give feedback to the AI, so it learns and increases accuracy.

3. Flags insufficient documentation: AI plays a crucial role in improving documentation accuracy, which is of vital importance when adjusting to the latest guidelines. If a diagnosis lacks enough supporting documentation, AI points out this error and acts as an early warning system to clinical teams. This forewarning allows staff to rectify and augment the documentation promptly. When healthcare organizations can catch a problem so early on, it prevents a whole flood of negative consequences further downstream in the revenue cycle, such as denied claims, delayed reimbursement, and underbilling. Avoiding this pitfall saves time, headaches, money, and ensures proper reimbursement from the start.

4. Comprehensively captures diagnoses: AI's ability to thoroughly review a patient's medical records means it excels at identifying nuanced diagnoses. Consider an encounter where a patient is primarily diagnosed with hypertension. A comprehensive AI analysis may uncover additional conditions assessed, such as peripheral artery disease or hypertensive heart disease, contributing to a more detailed patient profile. This detailed assessment permits the AI system to capture HCCs for accurate billing. Overall, the comprehensiveness and specificity of AI coding help to ensure that risk adjustment factors (RAFs) are determined accurately, enabling proper reimbursement.

5. Implements proper combination coding with ease: Comorbidities can be easily overlooked in a patient encounter. For example, if a patient who has chronic kidney disease comes in for an insulin refill, a physician may review his or her bloodwork and eGFR but not specifically account for the CKD with a code. Because the kidney disease is being monitored during the encounter, a combination code such as E11.22 can be used that captures both diabetes and CKD, leading to a higher-valued HCC. This is where AI can help. It will rigorously review the patient's medical records and spot this oversight, securing proper reimbursement.

Don't Let Guideline Changes Slow Down Your 2024

Coding guideline changes take a lot of work and can drag any healthcare practice down and hurt staff morale.

Working with AI can remove that burden and give healthcare organizations a head start. The reduced workload empowers staff to devote themselves to high-value tasks and progress on vital initiatives, instead of being bogged down with complex coding updates.

While this vision may sound hard to believe, it's already happening. AI is changing the medical coding game, not just for CMS-HCC-V28, but for all guideline updates in the years ahead. After reading about the five concrete ways AI can help healthcare organizations transition to new guidelines, are you ready to see what it can do for you?

Taylor (Ross) Webster is the Head of Coding Quality at Fathom, a health technology company that uses deep learning artificial intelligence to automate medical coding for a wide range of specialties and practices. Webster manages strategic analysis, client analytics, and reporting. www.fathomhealth.com

Practice Management

Thoughts Had ... Lessons Learned - U.S. Healthcare Challenges

Practice Management

The Stability Factor: Documenting Chronic Exacerbated Conditions

Practice Management

The Uniform Commercial Code and Its Relation to Hardware, Software, and Related Services Used by Healthcare Sector Participants

Practice Management

Monthly Spotlight on Fraud, Waste, and Abuse

Practice Management

Unlocking Revenue Potential: How Data Analytics Powers Smarter Revenue Cycle Management:In today's ever-evolving healthcare landscape, the pursuit of unlocking the full revenue potential of healthcare organizations stands as a paramount objective. With healthcare costs rising and the intricacies of medical billing becoming increasingly complex, the need for precision and insight in managing revenue has never been more critical. Data analytics has the transformative power in revenue cycle management to shed light on the strategies, tools, and real-world successes that can guide healthcare providers toward financial clarity and success.

Practice Management

Data Use Agreements: Utilization and Distinguishing from Business Associate Agreements:Any person in the healthcare industry knows or should learn that if they are considered a covered entity or business associate (including subcontractor), that creates, receives, maintains, and/or transmits protected health information (PHI), then a business associate agreement (BAA) is required. See 45 CFR §160.103, 45 CFR § 164.504. This is not a new phenomenon; in fact, it has been required for over 20 years.

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Tomorrow's Doctors: Evolving Trends in Healthcare Specialty Training:If you're in healthcare or aspiring to be, specialty training is where the rubber meets the road. It's the bridge from general medical knowledge to honed expertise in a particular field. You've probably caught wind of how specialty training in healthcare is not what it used to be. New tech, evolving patient needs, and a myriad of other factors are reshaping the landscape. As healthcare evolves with technology and societal needs, specialty training is undergoing a metamorphosis, aiming to create professionals who are adept at both traditional and modern healthcare practices.

Practice Management

Medical Practice Relocation Tips for Moving to a New Location:Roughly 40 million Americans relocate each year. In 2022 alone, the U.S. Postal Service processed over 33 million change-of-address forms. However, people aren't the only ones capable of moving – businesses can, too. If you are a healthcare provider in private practice that has decided to relocate your medical practice, the process will involve a lot more than a change-of-address form!

Practice Management

Decoding the Maze: Navigating Prior Authorization in Healthcare (Part 1):Picture this: You're at a hospital, and amidst the stress of an upcoming procedure, you're swamped with paperwork and concerns about the treatment's financial aspect. This scenario is all too common, and at its core often lies the concept of prior authorization.

Practice Management

Whistleblowers and Company Data: To Collect or Not to Collect:Before the thought, "Oh, I have access to all this information - ‘Come on Barbie, let's go party' 1" crosses a potential whistleblower's mind, there is one question to ask. "Should I collect documents from my employer or a person that I contract with to perform services?" This is critical to avoiding potential liability at both the employment and post-employment stages. What are the potential ramifications? It depends.

Practice Management

Choosing the Right Deductible:Often and easily forgotten is that the producer's role extends beyond simply selling insurance policies. Top shelf producers are trusted advisors not only to their clients, but carrier partners, as well. This article will focus on serving the employer. In this capacity, the producer may act as an extension of the employer's HR, finance, and executive departments. This may include advising on industry trends, policy updates, and emerging healthcare issues.

Practice Management

The American Healthcare System: A Problem in Need of Solutions:The United States spends more on healthcare than any other country in the world, yet it has some of the worst health outcomes. This is due in part to a number of problems with the American healthcare system, including:

Practice Management

Decoding the Maze: Navigating Prior Authorization in Healthcare:Picture this: You're at a hospital, and amidst the stress of an upcoming procedure, you're swamped with paperwork and concerns about the treatment's financial aspect.

Practice Management

Redefining Healthcare: An Exploration of Automation in the Digital Transformation Journey:In an era where digital technologies are transforming industries at an unprecedented pace, healthcare is no exception. The sector is undergoing a significant shift, driven by innovations that aim to enhance care delivery, improve patient outcomes, and reduce costs. Central to this digital transformation narrative is automation. This article will delve into the role of automation in redefining healthcare, exploring its significance and potential to shape the future.

Practice Management

Emotional Support Animals:An Emotional Support Animal (ESA) is a pet, prescribed by a licensed provider to a patient for their mental health, which provides emotional support to the individual. ESAs can be different types of pets, most commonly dogs and cats, and any age or breed. What they all have in common is they comfort their owners with companionship and improve their quality of life.

Practice Management

2024 Guide: 13 Steps of Revenue Cycle Management:In the ever-evolving world of healthcare, revenue cycle management (RCM) plays a crucial role in the success of any medical practice. Efficient RCM ensures timely and accurate payment for services rendered, which can significantly impact the financial health of a practice.

Practice Management

HHS Selects the First Drugs for Medicare Drug Price Negotiation:For the first time, Medicare will be able to negotiate prices directly with drug companies, lowering prices on some of the costliest prescription drugs.

Practice Management

ApolloMD Leverages Fathom Autonomous Medical Coding to Save Costs and Accelerate Revenue Cycle for 1,500+ Physician Group:Fathom's AI-based automated medical coding delivers industry-leading automation rates with improved accuracy, reducing ApolloMD's coding costs and alleviating coding staffing challenges

Practice Management

The Role of Artificial Intelligence in Revolutionizing Medical Billing Services for Physicians:In today's rapidly advancing healthcare landscape, medical billing has become a critical aspect of running a successful medical practice. Efficient and accurate billing processes are essential for healthcare providers to receive timely payments for their services. With the advent of artificial intelligence (AI) technology, medical billing services have undergone a revolutionary transformation. This article explores the role of artificial intelligence in revolutionizing medical billing services for physicians, highlighting the benefits and advancements brought about by this innovative technology.

Practice Management

Navigating Carrier Guidelines for Optimal Practice Reimbursement:When a Medicare patient has multiple sources of insurance coverage, Medicare will only pay for services after the primary payor has processed the claim and made their payment. Medical office staff must always verify the patient's insurance coverage thoroughly-gathering all necessary information from the primary insurance, such as policy numbers, claim submission instructions, and any preauthorization requirements, etc.

Practice Management

The Evolution of MIPS and Understanding the Upcoming Changes:In the world of healthcare, the Merit-Based Incentive Payment System (MIPS) plays an instrumental role in incentivizing providers to deliver high-quality, efficient patient care. However, staying up to date with MIPS can be a challenge as the program is subject to continuous changes and updates.

Practice Management

Proposed Rule for Medicare Physician Fee Schedule CY 2024 Sees Continued Decrease in Reimbursement:The Medicare Physician Fee Schedule (MPFS) Proposed Rule (PR) for Calendar Year (CY) 2024 was released on July 13, 2023. The PDF is available for review. Public comments are accepted for a sixty (60) day period through September 11, 2023.

Practice Management

Monthly Spotlight on Fraud, Waste, and Abuse:A physician was sentenced to two and a half years in prison for fraudulently obtaining and misappropriating approximately $250,000 from two separate COVID-19 relief programs.

Practice Management

Texas HHSC-OIG is Ramping Up Its Investigations of Medicaid Pediatric Telemedicine Claims:In the state of Texas, Medicaid plays a significant role in providing healthcare services to a large portion of the population. With more than 5.9 million Texans1 (approximately 18.9% of the current population2) enrolled in Medicaid, it is an essential program for qualifying low-income citizens. In Texas, Medicaid costs taxpayers over $40 billion.

Practice Management

Seven Reasons to Standardize Medical Records:The electronic health record (EHR) is widely used for documenting and managing the patient's medical record. In the 1980s, the first web-based EHRs were being introduced and used in healthcare facilities because computer hardware had finally become affordable.

Practice Management

ERISA - Overview for Healthcare Providers: Part I:In the United States, approximately 88% of the employees who are enrolled in employer-sponsored health insurance benefits have plans that are subject to ERISA regulations.

Practice Management

Becoming a Resilient Leader During Trying Times:Resilience is the ability to confidently face challenges, embrace change, recover from setbacks, and bounce back from adversities. This can be extremely difficult for leaders in today's healthcare environment. Increasing your resilience is easier said than done, especially post-COVID. This article provides insight to managers on how to succeed in a competitive, challenging industry.

Practice Management

The CERT Program: What It Is and What a Practice Needs to Know:The Comprehensive Error Rate Testing (CERT) program is a crucial component of the Medicare program that helps ensure the government is paying only for the services and care that beneficiaries actually receive. The program is designed to identify improper payments made to healthcare providers and suppliers under Medicare Part A and B and Durable Medical equipment MACs (DMACs). This article will explore what the CERT program is, how it works, what a practice should do if a CERT request for records arrives, and how the CERT report can be used to help a practice stay compliant.

Practice Management

Harness the Power of Patient Reviews to Elevate Your Practice:When was the last time you made a purchase without looking at product and service reviews? Amazon, Facebook, Google, Netflix, Uber, Travelocity - powerhouse, world-changing organizations all built upon the culture and value of reviews. Healthcare is not immune to the review culture; with our consumerized patient, positive public sentiment is liquid gold and one of your most valuable assets! In fact, 86% of top performing healthcare providers are asking for reviews and feedback after every patient encounter.

Practice Management

Transforming Rural Healthcare Delivery: The Mission and Vision of the Office of Rural Health:For many rural communities, accessing quality healthcare remains a challenge. Geographic isolation, insufficient medical facilities, and a lack of specialized care providers can create significant barriers to adequate care. Recognizing these issues, the Office of Rural Health was established with the goal of improving healthcare in rural areas. This article will explore the mission and vision of the Office of Rural Health and discuss how its initiatives are transforming rural healthcare delivery.

Practice Management

Part 1: Basics of Artificial Intelligence (AI) and Healthcare Compliance:Artificial intelligence (AI) technology has created new opportunities to progress on critical issues, such as health, education, and the environment. In some cases, AI may do things more efficiently or methodically than humans.

Practice Management

Freestanding Emergency Center (FEC) Industry Lobbying Goes to Washington:In early February, members of the National Association of Freestanding Emergency Centers (NAFEC) went to Washington D.C. to meet with various members of Congress to gain support for two items: the continued recognition of Freestanding Emergency Centers post pandemic and for oversight of the No Surprises Act Independent Dispute Resolution process.

Practice Management

The Significance of Not Obtaining Patient/Consumer Consent Before Poaching Data:Now, in 2023, the FTC announced two consent orders related to the prohibited poaching and use of PHI by known third parties and the DOJ announced another settlement under its Civil Cyber-Fraud Initiative.

Practice Management

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Practice Management

The Crucial Role of Negotiating Payer Contracts Every 18 Months for Physician Offices:The healthcare landscape is constantly evolving, with changes in technology, patient care, and the business of medicine all occurring at a rapid pace. One area that is often overlooked but is equally critical to the success and sustainability of a medical practice is the negotiation of payer contracts.

Practice Management

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Practice Management

Is the Violation Right of Access or Information Blocking? Do You Know the Difference?:The right of access and information blocking are both related to the access and exchange of health information, but they are different in several key ways. HIPAA Privacy/Security and Compliance Officers and Health Information Management professionals need to know the difference. It is important to differentiate between Right of Access and Information Blocking to ensure your organization is compliant with both rules, as well as any applicable state privacy regulations.

Practice Management

Healthcare Compliance: A Unique Opportunity to Impact the Business Side of Medicine:I have been privileged to make my entrance into the world of healthcare, in medical coding, specifically after my first career as an art historian dissolved way back in 2008 due to the recession. Mind you, I have taken all my research skills, writing, communication, and critical thinking strengths along for the ride.

Practice Management

Overcoming Self-Pay Challenges in Revenue Cycle Management:Amid the headlines of labor shortages and hospital closures, many Americans may have missed some positive recent healthcare-industry news: The U.S. reached a new, all-time low in the rate of Americans without health insurance.

Practice Management

FY24 IPPS Proposed Rule Boosts Hospital Payment Rates by 2.8%:CMS proposed a new rule for the fiscal year 2024 Inpatient Prospective Payment System (IPPS), increasing hospital payment rates up to 2.8%. Also, the newly proposed IPPS rule adopts policies that are aimed at advancing health equity.

Practice Management

Empowering Your Front Desk Staff to Improve your Revenue Cycle Management :The front desk is the first point of contact for patients visiting a healthcare facility, and it plays a crucial role in revenue cycle management. The front desk staff is responsible for managing patient registration, insurance verification, appointment scheduling, and collecting payments. Empowering your front desk staff can significantly improve your revenue cycle management and boost your bottom line.

Practice Management

Spotlight on Fraud, Waste, and Abuse - March 2023:The following cases highlight fraud, waste, and abuse (FWA) and serve as a reminder to uphold high ethical standards when providing patient care and services.

Practice Management

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Practice Management

The Importance of Selecting the Right EMR and PMS Software:As a healthcare organization, choosing the right electronic medical record (EMR) and practice management system (PMS) software is critical for the success and efficiency of your operations. The right software can streamline patient care, improve data accuracy and security, and reduce administrative burdens, among other benefits.

Practice Management

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Practice Management

Consensus Cloud Solutions to Showcase Healthcare Technologies that Enhance Interoperability at ViVE 2023:Consensus Cloud Solutions, Inc. (NASDAQ: CCSI), the world's largest provider of digital cloud fax technology, will be exhibiting their suite of interoperability solutions at the ViVE 2023 conference in Nashville, Tennessee, March 26-29th. Booth #1020

Practice Management

Five Steps for Provider Credentialing:When your facility hires a new provider, they need to be credentialed. This process allows you to verify their qualifications and skills while getting them approved to work with insurance companies. Medical credentialing is a time-consuming and expensive process that requires complete concentration by a professional. This can use a lot of your facility's resources.

Practice Management

5 Ways in Which Healthcare Data Visualization is Transforming Healthcare:

Healthcare providers can make use of data visualization to assess past and present medical history and improve patient care and outcome.

Practice Management

The End of the PHE: Medicaid, The Omnibus Act, and What Hasn't Been Addressed:An announcement on January 30th, by the OMB (Office of Management and Budget) and the White House, stated that they plan to end the COVID-19 national emergency and public health emergency on May 11th.

Practice Management

Three Ways Medical Groups Can Leverage Digital Self-Service to Drive Growth:That medical groups and health systems share a commitment to delivering convenient, high-quality care in their respective settings isn't surprising. What is eye-opening, however, is that despite their differences in size and structure, they face many of the same business challenges, such as fending off market competitors, acquiring and retaining patients to ensure profitability, and working to alleviate staff burnout.

Practice Management

How to Establish a Business Plan for Your Holistic Practice:Opening a holistic healthcare practice is an exciting and challenging endeavor that requires careful planning and preparation. A business plan is a critical tool that can help you to organize your thoughts, set goals, and create a roadmap for your practice's success. In this article, we discuss steps on how to establish a business plan for your holistic practice and provide some tips for creating a successful strategy.

Practice Management

CMS Announces Increase in 2023 in Organizations and Beneficiaries Benefiting from Coordinated Care in Accountable Care Relationships:Recently, the Centers for Medicare & Medicaid Services (CMS) announced that three innovative accountable care initiatives will grow and provide higher quality care to more than 13.2 million people with Medicare in 2023. More than 700,000 healthcare providers and organizations will participate in at least one of the three initiatives – the Medicare Shared Savings Program and two CMS Innovation Center accountable care model tests. This growth furthers achieving CMS's goal of having all people with Traditional Medicare in an accountable care relationship with their healthcare provider by 2030.

Practice Management

Investigation of Hospitals Hiding Prices from Patients:The Federal Hospital Price Transparency Rule helps Americans know the cost of a hospital item or service before receiving it. Compliance is mandatory. The regulation aims to improve the affordability of hospital care by promoting price competition. However, a low compliance level among hospitals would compromise the operational effectiveness of this regulation.

Practice Management

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Practice Management

Burnout: A Threat to Our Healthcare System?:The coronavirus disease 2019 (COVID-19) pandemic has generated a substantial increase in the workload of healthcare professionals, leading to physical and mental distress among professionals, resulting in an increase in burnout.

Practice Management

Digital Collaboration Maximizes Efficiency and Reduces Congestion in the Healthcare Ecosystem:CBS reports that excessive financial waste in our healthcare system ranges from $760 billion to $935 billion per year - that's more than the total for annual federal defense spending. The largest portion of this excess is administrative activities; these tasks required of physicians, their staff, and nurses are complex and devour so much time that they waste hundreds of billions of dollars each year.

Practice Management

Expanded Authorization for Non-Physician Providers:The opportunities for non-physician providers (NPP) in radiology practices continue to expand. Recently, the American College of Radiology (ACR) revised its CT and MRI facility accreditation criteria to allow NPPs to be able to directly supervise contrast administration.

Practice Management

12 Tips to Grow Your Medical Practice in 2023:If you are a private practice owner, you may feel it is difficult to attract new patients. By setting a plan and sticking to it, you can set yourself up for success in 2023. Medical practice management requires the collaborative efforts of all team members.

Practice Management

Value-Based Healthcare and Evidence-Based Treatment Rank Highest:Recently, we conducted a new survey on our LinkedIn asking respondents the question, "What do you see as the most important factor that technology solutions can solve to fuel better and more efficient patient outcomes in 2023?"

Practice Management

To Benchmark or Not to Benchmark: That Is the Question:Curiosity is both a blessing and a curse. Wanting to know how you compare to other practices can be so enticing that we are sometimes willing to accept assumptions that are not always supported by the evidence.

Practice Management

Demonstrating the Value of Patient Access in Challenging Times:It's no secret: Most healthcare organizations today are facing significant financial challenges - and there isn't a single culprit to blame. Instead, it's a perfect storm of circumstances fueled by an uncertain economy, workforce shortages, ongoing COVID-19 recovery, and public health issues such as RSV and the impact of delayed care.

Practice Management

The Medicare Advantage Bill Was Crafted in Response to Complaints:U.S. Senators Maggie Hassan, D-N.H., and Dr. Roger Marshall, R-Kansas, have introduced the bipartisan Medicare & You Handbook Improvement Act, which is meant to ensure that when seniors assess their Medicare coverage options, they have the necessary information they need on health plan choices and supplemental insurance.

Practice Management

The Advance Beneficiary Notice or ABN:An Advance Beneficiary Notice (ABN) is one of the most abused forms at a patient visit. When we, as a patient, seek medical care, that medical care is a covered or a non-covered service. If it is a covered service, that means that the service is payable by our health benefit plans.

Practice Management

The U.S. Government and Cooperation Credit in Relation to the False Claims Act and the Federal Anti-Kickback Statute:Those familiar with the healthcare industry have no doubt learned that the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and the U.S. Department of Justice (DOJ) have identified both the False Claims Act (FCA) and the Anti-Kickback Statute (AKS) as laws critical to thwarting fraud, waste, and abuse. Often, these two laws come together in a FCA case.

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Problems Addressed Regardless of the Place or Type of Service:I can't remember if I've recently covered this topic, so one of us (or maybe both of us) may have deja vu today. We're still getting inundated with questions about Problems Addressed regardless of the place or type of service, so whether I've already covered this topic or not, it bears addressing it again.

Practice Management

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Practice Management

DME Billing Coverage Limitations and Exclusions :Durable medical equipment (DME) billing is an essential aspect of revenue cycle management in the healthcare industry. As the industry evolves, DME has grown in importance and now serves millions of patients. However, managing the billing processes and reimbursements associated with DME can be time consuming and labor intensive.

Practice Management

How to Reduce Patient Collections in a Medical Office:Putting on the dreaded collections hat is a necessary evil that every medical office can relate to. You can run a tight ship, doing your very best to collect payments at the time of service, but because of the complexities of medical billing and emergent situations, there will always be times when collecting every patient's payment is an impossibility.

Practice Management

What Are SOAP Notes? (And Why They’re Important for Insurance Billing):Healthcare documentation is a critical component for your holistic practice, both in terms of delivering great care to your patients and for insurance billing purposes-not to mention the importance of having some form of documentation in the event of a legal situation.

Practice Management

Let's Talk about Weed (As in the Doctor):Early September marked my 33rd year on the administrative side of healthcare. This followed my 56th birthday in April when I officially entered the realm of "pushing 60."

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DENIED! CO 22-This care may be covered by another payer, per coordination of benefits?!?:Coordination of benefits can be described as when two or more insurance plans work together to determine the order of coverage liability. This coordination between plans exists to avoid duplicate payment, which could result in a provider receiving payment in excess of the services provided and the total amount billed.

Practice Management

A Cautionary Tale about Personal Injury Protection, Health Insurance...and Lawsuits:Medical providers who treat individuals for injuries sustained in motor vehicle accidents (MVAs) are frequently tasked with identifying the proper insurance carrier that is responsible for payment.

Practice Management

Medicare Patients and Stark Law: What You Need to Know:If your medical practice treats patients covered by Medicare, then you already know that there are countless regulations you need to closely adhere to in order to avoid any issues with the government.

Practice Management

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Practice Management

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Practice Management

Telehealth Here to Stay, But Technology Needs to Catch Up:Patient care in a post-COVID-19 world is significantly different for providers who are embracing virtual care options, such as telehealth and asynchronous texting.

Practice Management

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Practice Management

Thoughts Had...Lessons Learned ® The Selling of Marcus Welby, M.D. - Part 2:The basic economic business model as presented by Adam Smith in his book on capitalism, The Wealth of Nations, is shown below. Adam Smith was a Scottish social philosopher and political economist who wrote a major influential book on capitalism in the 1700s. You just never know where and from whom you are going to find your answers.

Practice Management

Thoughts Had...Lessons Learned ® The Selling of Marcus Welby, M.D. - Part 1:The first article I ever wrote for BC Advantage (BCA) Magazine was for the March/April 2017 issue. It was wishfully titled, "An Alternative to Private Practice Extinction."

Practice Management

Is Now the Right Time to Start a Medical Billing Company?:Occasionally, I receive a call in my office asking my advice regarding whether or not I think it is a good time to start a medical billing company. I never answer the question directly; rather, we have a discussion outlining the positive and negative aspects of running a billing company in today's healthcare environment.

Practice Management

You Play a Vital Role in Protecting the Integrity of the U.S. Healthcare System:The U.S. healthcare system relies heavily on third-party payers to pay the majority of medical bills on behalf of patients. Healthcare insurance fraud is a pressing problem, causing substantial and increasing costs in medical insurance programs.

Practice Management

Audio-Video Telehealth, Mobile Device Management, and You:This article addresses how to track telehealth policies while addressing HIPAA compliance and mobile device management as the United States enters a post-pandemic era.

Practice Management

Best Practices for Recruiting Front Desk Medical Staff:As medical practices bounce back from the pandemic, many are finding it challenging to recruit and hire great employees, including front desk staff.

Practice Management

Prepare for Telehealth After the End of Public Health Emergency:The state and federal Public Health Emergency (PHE) declarations related to the COVID-19 pandemic created wide latitude for providers to render services via telehealth in order to prevent the higher risk of in-person contact for patients, providers, and staff.

Practice Management

Outsourcing Strategy 101: Crucial Questions to Ask Healthcare Billing Companies:Healthcare billing companies are excellent partners to the mainstream medical industry-hospitals and independent or group clinics.

Practice Management

FACT SHEET: The Biden Administration Announces New Actions to Lessen the Burden of Medical Debt and Increase Consumer Protection:Vice President Kamala Harris announces reforms across four areas to ease the burden of medical debt, giving more American families the opportunity to thrive.

Practice Management

Improving the Patient Experience with Electronic Patient Statements:The most important part of any healthcare practice is helping patients. The second most important part is getting paid. Offering electronic patient...

Practice Management

Five Facts about Split Visits:Got five minutes? You can learn five things about the crazy 2022 rules for Split Visits. Hopefully, this will end a lot of the confusion around these relatively new rules.

Practice Management

Offsetting Staffing Shortage-Induced Revenue Loss:Exacerbated by pandemic-induced burnout, the Great Resignation, vaccine mandate-driven terminations, and rising retirement rates, the chronic shortage of billing, coding, and audit professionals will continue to worsen over the near future.

Practice Management

Improving Accounts Receivable for Effective Revenue Cycle Management:Collecting amounts that have been billed or accounts receivable is essential for successful revenue cycle management.

Practice Management

The Importance of Mental Wellbeing in Modern Healthcare Practices:Supporting the mental health and wellbeing of healthcare workers should be the number one priority of every healthcare manager and practice owner. The importance of essential workers and first-line medical staff is evident now more than ever.

Practice Management

The Road to Professional Success and Recognition!:The Professional Association of Health Care Office Management, Inc. (PAHCOM, pronounced "PAY-COM") has been providing efficiency concepts, productivity, and networking knowledge since 1988.

Practice Management

Using Software to Grow Your Medical Billing Company:Here's a simple truth: the faster you can get your customers paid, the more popular your medical billing company will be. Now here's another one: no matter how effective your team is, you will only ever be as efficient as your software allows to grow your medical billing company.

Practice Management

No Surprises Act Compliance:The Department of Health and Human Services published three parts to the No Surprises Act towards the end of 2021, which took effect January 1, 2022.

Practice Management

8 Tactics to Improve Revenue Cycle Management for Your Practice:Whether you're part of a larger hospital or run your own private practice, improving revenue cycle management means improving your bottom line.

Practice Management

Insulate Your Revenue Cycle Management Process from the Surprises of the No Surprises Act:Last year, the U.S. government announced an interim final rule (IFC) related to the Surprise Billing Act. The rule defines the No Surprises Act's requirements for group health plans, carriers and payers, medical service providers, and other ancillary services.

Practice Management

What's Your EQ?:Most people have had interactions with physicians who are intelligent, nice people but have awful bed-side manners. Or a practice manager that seems oblivious to staff members' feelings or personal situations.

Practice Management

No Surprises Act and Good Faith Estimate Considerations for Behavioral Health Providers:Overview: Enacted as part of the Consolidated Appropriations Act of 2021, Pub. L. 116-260 (Dec. 27, 2020), the No Surprises Act (NSA) and the related regulations, which became effective January 1, 2022, should have a positive impact for patients.

Practice Management

Coding for a Performance of an X-ray Service vs Counting the Work as a Part of MDM:When x-rays are audited on the same date as an E/M encounter, we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally.