The below articles are all published in BC advantage
Magazine and written and contributed by BC Advantage
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Capturing HCCs in a Changing World
On March 31, 2023, the Centers for Medicare and Medicaid Services (CMS) released the CY 2024 Medicare Advantage (MA) Capitation Rates along with Part C and Part D payment policies. The largest key decision in the release was the finalized propo...
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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 au...
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Reviewing the Guidelines for Reporting ICD-10-CM Aftercare Codes
Aftercare codes are assigned to explain encounters where the initial treatment of a disease has been completed and the patient encounter is now focused on aftercare for healing and recovery. These codes may also be reported to explain long-term conse...
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AI Auditing: Walking Backward Toward Home
Way back in 1976, as an elementary school kid in the suburbs of Philadelphia, I came across a book in the library called 2010: Living in the Future. In my then-current world of AMC Pacers and seersucker suits, the book promised great things.
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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 employe...
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Truly Autonomous Coding Requires a Multifaceted Solution
Coding technology has come a long way since the days when Computer-Assisted Coding (CAC) was a bleeding edge feature of the more advanced encoder solutions. Today's CAC solutions are often integrated with Clinical Documentation Integrity (CDI) tools ...
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Introduction to Telebehavioral Health
Delivering mental health services via telehealth has increased since the COVID-19 pandemic. Both federal and state rules are constantly evolving along with the use of Artificial Intelligence (AI), creating a complex environment for compliance conside...
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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 financia...
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Understanding Gastroesophageal Reflux Disease and ICD-10-CM Coding
GERD stands for Gastroesophageal Reflux Disease, a chronic condition where stomach acid flows back into the esophagus, causing a range of symptoms, such as heartburn, regurgitation, chest pain, difficulty swallowing, and a chronic cough.
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The Hidden Costs of Using an Ineffective Payment Processing System
At any given time, over a billion payments are being processed online, and this includes healthcare services. That's because patients today want the ease and speed of transactions that traditional methods simply don't offer. Plus, healthcare practice...
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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 ...
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E/M Scoring Questions
Evaluation and Management visits are often the "bread and butter" of an organization. Thus, correctly scoring encounters is essential to ensuring proper reimbursement. The element of "Risk" is only one of the three elements of Medical Decision Making...
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