September 28, 2020
CMS Reaffirms the Rights of Non-Contracted Providers
EDITOR’S NOTE: Edward Hu, MD, CHCQM-PHYADV, a past president of the American College of Physician Advisors, also contributed to this article. Dr. Hu and Dr. Banker both participated in a series of meetings with Centers for Medicare & Medicaid Services (CMS) officials, with the end result being the recently issued…
February 25, 2020
New Directions for Medicare Advantage and the Medicare Drug Plan in 2021
Comments on the proposals set forth in Part I and Part II of the advance notice must be submitted by March 6, 2020. The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage (MA, or Part C) and the Medicare prescription drug benefit…
January 14, 2020
Looking at Possible ICD-10-CM Clinical Coding Challenges in 2020
Seven coding challenges reveal a new compliance landscape in 2020. It’s here: 2020! This past year in healthcare, as in many years before, was full of changes, challenges, and some surprises as well. When trying to foresee the key future challenges in clinical coding, the following topics came to mind…
May 14, 2019
UPMC versus Highmark – Can UPMC Pop Champagne Corks?
The saga continues between UPMC hospitals and Highmark. UPMC reported revenue of $5.1 billion in the quarter ending March 31, 2019, up 10 percent from the $4.6 billion reported in the first quarter of last year. At the same time, expenses rose by more than 11 percent. Since revenues are…
March 19, 2019
ONC, CMS, NCVHS Weighing in on Improvements
National healthcare entities are teaming up and speaking out on how to make healthcare better. EDITOR’S NOTE: The following was discussed by Nachimson during last Tuesday’s Talk Ten Tuesdays live broadcast. There are two major and complementary rules to advance interoperability being proposed by U.S. Department of Health and Human…
July 10, 2018
Incorporating Socioeconomic Status for Medicare Advantage: Addressing the Social Determinants of Health
Accounting for socioeconomic factors is critical to the sustainability of healthcare. A recent blog headline in the American Council of Science and Health captured the healthcare industry’s attention. The headline read, Medicare Could Cover Food, Air Conditioners...Is Sex Next? The focus was on recent action by the Centers for Medicare…
March 27, 2018
UnitedHealthcare Begins Crackdown on Level 4 and 5 ED Codes
Three key takeaways from this effort by healthcare giant UnitedHealthcare UnitedHealthcare (UHC) is continuing its quest to revamp many facets of our healthcare industry. Last year, they adapted mandatory policies for the use of the SA modifier to indicate that a professional service was performed as incident-to, and now the…
