Doing what’s right is never wrong! Over the last six months we’ve all read the disappointing stories about some of the missteps (intentional or unintentional) made by some of the major Medicare Advantage (MA) insurers. Both Humana and Anthem did not have adequate or effective safeguards in place to detect…

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…

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…

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…

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…

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…

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…

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…