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The struggle to keep up with electronic health record (EHR) upgrades is an area of concern for revenue cycle professionals, finds a Navigant/Healthcare Financial Management Association analysis.
HHS’ semiannual agenda, published in October, included a request for information (RFI) on provisions of HIPAA that may be stalling progress toward increasing coordinated care and case management among hospitals, physicians, payers and patients, and impeding the transformation to value-based payment systems.
A denial represents the health care insurance company’s decision not to adjudicate the claim because of a conflict over service, payment or coverage. Starting from this perspective, the appeal strategy must begin with identifying the payer. Next, determine whether the health care insurance is classified and managed as a commercial or government payer and whether the provider’s organization is a contracted or non-contracted entity.
Within the past two years, Medicare began issuing a separate payment for chronic care management (CCM) services under CPT code 99490. In 2017, CMS issued new guidelines to provide greater specifications and updated details to improve CCM documentation and billing. This article provides guidance on correct coding, billing and documentation for chronic care conditions in health care as defined by CMS and effective in 2018.
Practices that report definitive drug tests continue to struggle with high denial rates, the latest Medicare Part B billing data for the tests shows. Because CMS has worked to curb improper reporting of the services, continued high denials may trigger audits and other intrusive measures. If investigators get involved, they could use strong-arm methods to wring large settlements out of practices.


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