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.
Claim submission and denial management are critical components to the revenue cycle of healthcare facilities. As regulations are getting more stringent with the transition to value-based care, healthcare providers are facing an increase in claim denials. It therefore comes as a surprise that nearly one-third of clinicians are still using manual processes to manage their claim denials.
April 28, 2016 witnessed the release of the proposed rule that is intended to guide the implementation of MACRA (Medicare Access and CHIP Reauthorization Act of 2015) which aims to reward clinicians and physicians engaging in activities that support and drive positive patient outcomes. MACRA, once implemented in totality, will change the way physicians taking care of Medicare patients are paid by CMS.
The increase in audits has made them more of a rule than an exception. Each year, approximately 9% of physicians undergo a RAC audit. According to projections, within the next eleven years, every eligible physician will face a RAC audit. Insurance companies and government agencies are using the audit to recover improper claims payments as the rising cost of healthcare is impacting their bottom lines like never before.
In order to keep your practice afloat, it is imperative that your services receive full and timely reimbursements. Getting your cash flow moving smoothly depends on accurate coding along with timely submission of your bills to the relevant insurance carriers. Incorrect coding can lead to your reimbursements being delayed, denied or rejected. If you have a small or specialty practice,
Healthcare facilities across the nation have or will have to face Medicare audits at some point. Even those healthcare facilities that have done everything correctly and have never had to face an audit till date cannot be certain that it may not happen in the future. An audit could be due to a single payment or a multitude of payments – in either case,