After ICD-10 went live on October 1, 2015; CMS (Centers for Medicare and Medicaid Services) allowed a one year grace period for ICD-10 flexibility, to overcome the strong opposition from the AMA (American Medical Association) to ICD-10 implementation. For the one year period, even though a more specific code existed, CMS allowed healthcare providers to submit claims with a valid code from the ICD-10 three character category,
Healthcare revenue cycle management has undergone a radical and drastic change in the last decade. From days when most patients had $20 or so as co-payments and insurance companies paid claims in full, to today, when the physician first needs to consider medical necessity before ordering a lab test – things have certainly become more complex and challenging.
Starting August 1, 2016, the penalties under the False Claims Act (FCA) along with the Anti-Kickback Act, The Program Fraud Civil Remedies Act and a host of other Acts have nearly doubled to a minimum of $ 10,781 and a maximum of $ 21,563. A result of the interim final rule issued by the Department of Justice,
Ever since the RAC audit has been introduced, there is an element of fear amongst healthcare facilities with regards to the RAC program. Fuelled by rumors and myths, most of these fears have been proved to be baseless with the CMS (Centers for Medicare and Medicaid Services) addressing these fears through conferences, write-ups and articles.
The risk of personal identifiable information falling into the wrong hands or even finding its way into the public domain is a fear that we constantly live with, in this age of digital records and internet. We saw the reality of this fear when personally identifiable information of about 80 million individuals was potentially exposed by the data breach at Anthem.