This section includes coverage on the many facets of the revenue cycle food chain for hospitals and physician group practices. Topics span insurance eligibility, charge capture, claims coding, claims submissions, claims clearinghouses, and back-end follow-up with insurance companies to rectify claims denials and resubmission requests.
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Im not really sure where the Centers for Medicare and Medicaid Services is trying to go with the two-midnight rule, but I fear its backwards.
It's not much--just a simple statement posted on the Centers for Medicare and Medicaid Services website. However, it appears that CMS has broken its silence regarding the ICD-10 implementation delay.
Healthcare organizations were caught flat-footed by the one-year delay in the ICD-10 implementation deadline to October 2015, according to the finding of a new poll by the health services research arm of Deloitte LLP. The poll of 1,250 health professionals conducted during a recent Deloitte Center for Health Solutions webcast found that 58 percent of respondents were disappointed by the delay.
Congress may have blindsided the healthcare industry by delaying the ICD-10 code sets for at least a year, but there is real opportunity now for providers to get more benefit from the code sets than they otherwise may have.
A review of Medicare home health services by the Department of Health and Human Services' Office of Inspector General has found that 32 percent of claims did not document the required face-to-face encounters, resulting in $2 billion in payments that should not have been made. In addition, OIG concludes that oversight of the face-to-face requirement by the Centers for Medicare and Medicaid Services is minimal.
Now that the ICD-10 delay is the law of the land, you would have thought that the Centers for Medicare and Medicaid Services would have communicated something on the code switchover process going forward. But, a quick check of the CMS website still lists the ICD-10 deadline as October 1, 2014.
Anthem Blue Cross and MemorialCare Medical Foundation, the physician division of the Fountain Valley, Calif.-based MemorialCare Health System, are collaborating to offer Anthem's Enhanced Personal Care program in Orange County and the greater Long Beach region to customers of Anthem's Preferred Provider Organization.
The one-year extension of the ICD-10 implementation deadline signed into law April 1 by President Obama is viewed as a "positive credit development" for not-for-profit hospitals, according to New York-based financial information services company Fitch Ratings.
In the era of high-deductible plans, managing patient collections is sure to become one of the biggest revenue cycle challenges. Now, providers must do far more than establish insurance eligibility or qualify patients for charity care.
The Centers for Medicare and Medicaid Services expects soon to publicly post Medicare payment information on more than 880,000 healthcare professionals in all 50 states.
The Centers for Medicare and Medicaid Services spent many months telling stakeholders that the ICD-10 compliance deadline was firm--even before the agency had done its own testing. Now that Congress, with a push from physician groups, has delayed the compliance date at least another year, it is providers, payers and vendors that were on schedule to be ready that will be the ones being punished.
The federal government, in its new report on creating a risk-based regulatory framework for health information technology, focuses on the functionality of HIT products, not the platform whether it be cloud-based, installed or mobile.
With President Obama's April 1 signing of legislation into law delaying ICD-10 implementation to October 2015, supporters of the one-year extension believe that now is the time for Congress to get more actively involved in the code switchover. Despite including legislative language calling for the ICD-10 delay in the Protecting Access to Medicare Act of 2014, they say lawmakers have been relatively silent on the issue.
House and Senate passage of legislation delaying the ICD-10 implementation deadline by one year to October 2015 is proof that the Centers for Medicare and Medicaid Services' approach to the code switchover is flawed and CMS must "reset" the process, argues Robert Tennant, senior policy advisor at the Medical Group Management Association.