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Patient insured, but can’t afford care? Seek terms with payer for a cost break

12/19/2022

With high-deductible plans on the rise, it’s increasingly likely that you’ll see patients who, though insured, can’t afford their coinsurance payments. You can offer help, but take care not to run afoul of your payers.

Billing incident-to? Block 3 threats to the direct supervision requirement

12/19/2022

by: Julia Kyles, CPC

When physicians push for new and creative definitions of incident-to billing, it is up to coding and compliance staff to explain the rules. Watch out for mistake-prone areas to avert billing errors.

New prior auth rule aims for API adoption, 7-day turn by 2026

12/19/2022

by: Roy Edroso

Prior authorization, longtime bane of providers, is on track to get less burdensome thanks to a new proposed rule. The good news is it includes Medicare Advantage, left out of a previous version. But results, already delayed once, may still come slowly.

Incorporate updates, addendums to medical records while maintaining compliance

12/19/2022

by: Holly Cassano, CPC, CRC

Since the adoption of electronic health records (EHR) became commonplace in hospitals and medical practices nearly two decades ago, more people have access to the records than before. Now more than ever, the practice of keeping accurate records has shifted to accommodate the move from paper to screen.

CMS’ prior authorization reform would reap $15B over 10 years

12/19/2022

by: Richard Scott

A CMS plan to streamline the prior authorization process for certain payers would slash the amount of time spent chasing approvals and save providers billions.

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