3 Most Commonly Asked Questions About COVID-19 Vaccine Billing & Coding

With the end of the Public Health Emergency for COVID-19 nearing, learn how private practices and physicians can prepare—especially when it comes to medical billing. Get clear on what strategies will ensure continued success with physician billing solutions from NCDS.

Private practices have unique billing challenges. Learn how to enact physician billing solutions to make the most of your practice and provide quality patient care.

Automated medical billing helps practices recover payments, stay on top of the revenue cycle process, and free up medical practice staff’s time. NCDS Medical Billing has identified the benefits that practices receive as a result of automated medical billing.

This constitutes an important step in easing the excessive administrative burden on healthcare providers, removing unnecessary roadblocks in reimbursement.

Medical billing can be a challenge for small medical practices. The good news is that NCDS Medical Billing has all the tips and insider knowledge on how to find a great medical billing partner.

This legislation constitutes a fundamental and positive change to the Physician Fee Schedule and healthcare providers at-large.

NCDS Medical Billing has vast expertise in the mental health billing space. Read on to understand the differences between medical and mental health billing, and simplify your practice’s mental health billing efforts.

The flu vaccine is an important part of staying healthy during the winter months, and it’s especially important for pharmacies to stock up on this year’s vaccine. As you and your pharmacy prepare for the 2022-2023 flu season, NCDS Medical Billing has identified the key things to keep in mind.

Revenue-driving pharmacy benefits are only applicable if clinical services are successfully reimbursed. Pharmacy medical billing can be challenging – and NCDS Medical Billing is here to simplify that process.

Do you want to learn the basics of pharmacy medical billing? This article will provide you with everything you need to know about it.

NCDS Medical Billing is recognized by the program to protect patient privacy, prevent medical billing fraud, and comply with federal regulations.

Patients have medical insurance to help pay for these costs, so denials can be an overwhelming roadblock. Avoiding and resolving denials are the key to maintaining a healthy patient and a healthy cash flow. Read on to learn about our tips for how to avoid, manage, and resolve denials for patients and for practices.

Clean claims drive the overall revenue of health care providers and provide a healthy cash flow. Each time claims get denied, they weigh down your accounts and hold up the revenue your medical practice brings in. Denials become costly from a valuable time and financial perspective – so getting it right is important to your revenue stream, keeping your practice moving forward efficiently.

Revenue collection is a tricky tightrope act. You understand that paying for health care can be challenging for patients, but you also need their payments to continue providing them with the care they need.

Both your healthcare practice and your patients lose out when patients don’t show up for their appointments. In the United States, the annual cost of patient no shows is $150 billion. On a more micro level, individual physicians lose $200 per missed time slot.

While your patients’ wellbeing is your number one priority, your practice needs a consistent, steady stream of income to provide your patients with the best quality care and treatment.

One fact that everyone can agree on: COVID-19 has made a significant impact on the world. The world has adapted and changed greatly over the last couple of years. Read about the most common myths and facts about the vaccine.

The Food and Drug Administration authorized Pfizer and BioNTech’s Covid-19 booster shots for people 65 and older and other vulnerable Americans six months after they complete their first two doses, making many Americans eligible to receive the shots now.

While the COVID-19 delta variant continues to fuel outbreaks across the U.S., there is still uncertainty as to what this year’s flu season will bring. To bolster prevention efforts, one-stop clinics offering shots for both illnesses have started to emerge, CNN reported Sept. 21. The latest COVID-19 surge has pushed Idaho to activate crisis standards of care for hospitals and health systems statewide.

When the CDC released its latest round of recommendations regarding seasonal flu vaccines, the agency made one notable update: Flu vaccines and COVID-19 vaccines can now be given simultaneously.

The AMA has released the 2022 Current Procedural Terminology code set, which incorporates a series of 24 vaccine-specific codes that are the model for efficiently reporting and tracking immunizations and administrative services against the coronavirus (SARS-CoV-2).

President Joe Biden has unveiled a new “action plan” plan to confront the COVID-19 surge that’s being driven by the spread of the delta variant. It mandates vaccines for federal workers and contractors and certain health care workers, requires employees at companies with 100 or more workers to be vaccinated or tested weekly, lays the groundwork for a booster shot campaign and recommends that large venues require proof of vaccination or a negative COVID test. The plan also makes recommendations on keeping schools open.

NCDS is pleased to celebrate its 36-year anniversary since its founding on August 28, 1985, as well as announce the company’s relocation to a new office located at 19645 Progress Drive in Strongsville, Ohio.

The policy is meant to ensure that at-risk patients in smaller settings have the same opportunities as others to receive the vaccination.

The Ohio Department of Medicaid (ODM) today projected a go-live date for the Next Generation managed care launch for July 1, 2022.

The U.S. will likely offer booster shots for fully vaccinated Americans six months after their last COVID-19 vaccine was administered, instead of the eight-month gap that had been previously announced, a source familiar with the planning process told The Wall Street Journal Aug. 25.

Seventy-two percent of the country’s largest health plans are no longer waiving out-of-pocket costs for COVID-19 treatment, according to research released Aug. 19 by the Peterson-KFF Health System Tracker.

Despite this help, the economic impact of COVID-19 still weighs heavily on healthcare providers and practice staff. To ensure a healthy future and help ease the burnout providers and staff contend with, practices must take a hard look at their internal operations and make changes that put them on solid financial footing. A key to this is optimizing the revenue cycle.

The national outlook is worsening quickly, with a fourfold increase in new cases per day over the last month. Hospitalizations and deaths are also growing, but at far lower rates than cases.

Florida, Texas and Missouri accounted for 40 percent of new COVID-19 cases reported nationwide this week, Jeff Zients, the White House’s COVID-19 response coordinator, said July 22.

The American Medical Association (AMA) raised concern today that Congress seems “indifferent” to the fiscal uncertainty facing the Medicare physician payment system. In a letter to congressional leaders, the AMA pointed out that physician practices face a 9.75 percent cut on January 1.

The U.S. Supreme Court on June 28 declined to hear an appeal challenging HHS’ site-neutral payment policy, allowing reimbursement cuts to move forward, according to Bloomberg Law.

Young adults are less likely to be vaccinated against Covid-19 than other age groups—and nearly 25% of those between 18 and 39 said they probably or definitely won’t get vaccinated, according to data from CDC.

The U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA) is releasing revised reporting requirements for recipients of Provider Relief Fund (PRF) payments. This announcement includes expanding the amount of time providers will have to report information, aims to reduce burdens on smaller providers, and extends key deadlines for expending PRF payments for recipients who received payments after June 30, 2020.

The Healthcare Business Management Association announced that NCDS Medical Billing has earned re-accreditation under the HBMA Compliance Accreditation Program and offered its congratulations.

Virtual visits are here to stay, but how can medicine measure telehealth’s value to ensure that physicians and other clinicians, patients, payers and society are getting the most possible from the technology?

Health care providers are tasked with safeguarding the general population’s health. Though it is essential for them to do everything that guarantees the health of their patients, they should also protect their financial health.

HHS program reimburses healthcare providers and facilities for testing, treatment, and vaccine administration fees associated with insured patients.

Though several things have changed the way the world works, few have had as much an impact as the coronavirus. This respiratory infection has been announced by the WHO as a pandemic, with governments worldwide taking different steps to curb its spread.

At the start of the pandemic, a few medical practices assumed that this would mean a boom in profits for them. Even so, many suffered losses with most patients opting out of elective surgeries and in-person visits.

The coronavirus pandemic has dramatically altered the telehealth landscape, pushing providers to adopt or expand connected health platforms and tools to meet the demand for virtual care to replace in-person services.

In line with its growth and development strategy to enhance profitability and expand its services in the First Quarter of 2021 throughout the Midwest and Eastern United States, NCDS is pleased to announce that it has acquired new clients in Ohio and New York.

At the start of the pandemic, a few medical practices assumed that this would mean a boom in profits for them. Even so, many suffered losses with most patients opting out of elective surgeries and in-person visits.

If you’re in the medical field, chances are that your patients will have questions about the deductibles for their services. Read our article that breaks down patient deductibles.

A two percent cut to Medicare reimbursement will be paused until the end of the year, CMS recently announced. The announcement via the MLN Connects newsletter on April 16th stated that the Medicare sequestration will not be applied to Medicare fee-for-service claims through Dec. 31, 2021, per a new federal law.

ODM announced the selection of six managed care plans to lead the department’s evolution of managed care services for its more than 3 million members and thousands of medical providers…

Unclear about what MIPS entails for your medical practice? Here are some guidelines that seek to answer the common questions you might have about this reporting system.

The 2021 AMA National Advocacy Conference is normally held in Washington, with traditional highlights including visits to Capitol Hill where physicians meet with their senators and representatives to seek their support in addressing the concerns of their patients and colleagues.

Medicare spending on physician services decreased by $9.4 billion, or 19 percent, in the first half of 2020 because of the COVID-19 pandemic, according to a new analysis from the American Medical Association (AMA).

What’s the news: President Joe Biden’s administration is nearly doubling the Medicare payment for administration of the COVID-19 vaccine, raising it from $23 to $40, effective immediately.

Telemedicine will not revolutionize health care on its own, but the experience of millions of Americans during the pandemic assures us that it will become a permanent fixture of the health care ecosystem – one likely to account for a growing share of revenue in our $4 trillion health care economy.

A priority bill for the house of medicine has completed its journey through both chambers of the Texas Legislature. Now, the state’s pending tax on medical billing services is just one signature from Gov. Greg Abbott away from disappearing – which would keep physicians from paying passed-down costs from outsourced medical billing companies.

When running a medical practice, it is advisable to remain vigilant to avoid bad debts that will cripple your business.

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow.

As it responds to the critical situation caused by the novel Coronavirus, the entire team at NCDS remains committed to updating its valued health care clients with the most up-to-date news about changes to medical billing and coding, as well as with rules and regulations.

Are you looking to improve your billing procedure and collection methods? We offer top medical billing tips from the experts around.

Are you searching for ways to improve your medical bill collections? Don’t worry anymore. Here are some tips to improve patient collections.

Are you finding it challenging to manage an error-free medical billing system? Have you ever thought of outsourcing your medical billing? That’s easy; we will share three benefits of outsourcing medical billing.

While physicians worked to keep their practices financially afloat and dealt with COVID-19, hackers kept busy, too. From January through October of last year, there were 730 publicly disclosed security breaches with more than 22 billion records exposed, according to the cybersecurity firm Tenable.

The Centers for Medicare & Medicaid Services (CMS) is implementing multiple flexibilities for the Quality Payment Program (QPP) in response to the 2019 Novel Coronavirus (COVID-19) pandemic public health emergency (PHE).

Do you want to know whether the growing need for medical compliance in the healthcare industry is REAL? Well, yes. It’s happening and is real.

In this article, we will give you an insight into successful medical credentialing. Learn the basics of what medical credentialing is and why it’s important for both patients and healthcare practitioners.

Does maintaining regulatory compliance bother you? Don’t worry. We will offer the solutions to the most common medical compliance issues.

Short answer, yes, but, there are exceptions for certain employees raising certain objections.

There are several similarities and differences between COVID-19 and flu. Do you know what they are?

The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31.

The novel coronavirus (COVID-19) continues to affect millions of lives and every aspect of the US economy.

For office/outpatient E/M visits, the 1995 and 1997 E/M guidelines will no longer be used effective January 1, 2021.

Short answer, yes, but, there are exceptions for certain employees raising certain objections…

UnitedHealth Group’s Optum announced on Wednesday that it would acquire Change Healthcare with the aim of more effectively simplifying core clinical, administrative and payment processes…

The Biden administration has announced that it will begin shipping about 1 million COVID-19 vaccine doses a week directly to thousands of pharmacies in an attempt to address equity concerns and speed up the country’s crucial inoculation effort….

With its unwavering efforts to stay ahead of the latest billing trends and to enhance the customer experience for both medical providers and practices, NCDS is instituting an innovative approach to implement Covid-19 vaccine billing solutions.

As a member of the healthcare industry, it’s vital to be aware of medical terminology and coding. These codes translate a patient’s treatment and billing details into a language that is useful for claims submission and receiving reimbursements in return. Codes are valuable, but understanding what corresponds to them is more important.

In conjunction with its firm commitment to improving the process for implementing healthcare system changes in light of the extraordinary challenges from the Coronavirus global pandemic, NCDS officially added Covid-19 Immunization billing to its extensive list of services.

As a medical facility or healthcare provider, you aim to provide the best possible medical solutions, determining the right diagnosis and treatment plan for your patients. You also manage the costs of running your health facility.

In the healthcare industry, medical billing and revenue leakages can result in significant loss because of long payment cycles. These include the billing process, right coding insertion, and raising claims for insurance companies to receive quick money reimbursement.

Revenue cycle management (RCM) is essential to every business. And, it bears paramount importance in the healthcare industry. During a public health crisis like the Covid-19 pandemic, it has become vital to keep healthcare centers in operation.

Whenever or wherever a revenue leakage report surfaces, you’ll find that there are alternative solutions, methods, and strategies to fix such leaks. In order to prevent these problems from impacting your practice, It’s important to keep yourself prepared and overcome the loop-holes in your management, inventory, finances, operations, and billing.

It’s vital for healthcare providers and medical practices to utilize precise and error-free practice management software for the medical billing process in order to optimize their credibility and revenues, saving them both time and money.

Industry News2021 MEDICARE PAY SCHEDULE EASES PHYSICIANS’ DOCUMENTATION BURDENSRES ACT – PROVIDER RELIEF FUNDBack To All PostsNews2021 Medicare pay schedule eases physicians’ documentation burdensKEVIN B. O’REILLY – AMA-ASSN.ORGThe final 2021 Medicare physician payment schedule includes a simpler, more flexible process for coding and documenting evaluation and management (E/M) office-visit services. But those positive changes, set

Industry NewsCMS FINALIZES PHYSICIAN PAYMENT RULE FOR 2021: 6 TAKEAWAYSBack To All PostsNewsCMS finalizes physician payment rule for 2021: 6 takeawaysAYLA ELLISON – TWITTER.COMCMS released its annual changes to the physician fee schedule for 2021, which updates the payment rates for physician services and expands the list of telehealth services covered by Medicare.Six takeaways from

Industry NewsCMS ISSUES FINAL 2021 PHYSICIAN FEE SCHEDULEBack To All PostsNewsCMS issues final 2021 Physician Fee ScheduleTODD SHRYOCK – MEDICALECONOMICS.COMConversion factor drops by 10%, but some practices will benefit from increased E/M coding levels.CMS issued the final rule for the 2021 Physician Fee Schedule and doctors will see a conversion factor of $32.41, a decrease

After some delay due to the COVID-19 pandemic, CMS has released the final rule for the 2021 Medicare Physician Fee Schedule. The final rule unveiled by CMS yesterday evening will dictate how much Medicare physicians get paid for delivering care starting January 1, 2021. In the rule, CMS finalized a conversion factor of $31.41, which is a decrease of $3.68 compared to the previous year’s conversion factor.

On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2021.

Industry NewsMCLAREN ST. LUKE’S SUES PROMEDICA OVER DROPPING COVERAGEBack To All PostsNewsMcLaren St. Luke’s sues ProMedica over dropping coverageTOLEDOBLADE.COMMcLaren St. Luke’s Hospital announced Wednesday it has filed a federal antitrust lawsuit against ProMedica Health System alleging anticompetitive business practices.The Maumee hospital seeks to stop ProMedica from terminating the hospital and its physicians from the commercial and

Industry NewsAMA UPDATES CPT CODE SET TO INCLUDE COVID-19 VACCINE CODESBack To All PostsNewsAMA Updates CPT Code Set to Include COVID-19 Vaccine CodesJACQUELINE LAPOINTE  – REVCYCLEINTELLIGENCE.COMThe organization approved a unique CPT code for each of two COVID-19 vaccines to allow for better tracking, reporting, and analysis of immunization efforts.November 11, 2020 – The American Medical Association

Industry NewsRENEWAL OF DETERMINATION THAT A PUBLIC HEALTH EMERGENCY EXISTSBack To All PostsNewsRenewal of Determination That A Public Health Emergency ExistsOCT 2, 2020 – PHE.GOVAs a result of the continued consequences of the Coronavirus Disease 2019 (COVID-19) pandemic, on this date and after consultation with public health officials as necessary, I, Alex M. Azar II,

Industry NewsCOVID-19 EMERGENCY DECLARATION BLANKET WAIVERS FOR HEALTH CARE PROVIDERSBack To All PostsNewsCOVID-19 Emergency Declaration Blanket Waivers for Health Care ProvidersNOV 18th 2020 – CMS.GOVThe Trump Administration is taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take proactive steps

Industry NewsCMS CHANGES MEDICARE PAYMENT TO SUPPORT FASTER COVID-19 DIAGNOSTIC TESTINGBack To All PostsNewsCMS Changes Medicare Payment to Support Faster Covid-19 Diagnostic TestingOct 15, 2020 – CMS.GOVUnder President Trump’s leadership, the Centers for Medicare & Medicaid Services (CMS) today announced new actions to pay for expedited coronavirus disease 2019 (COVID-19) test results. CMS previously took action in April

Industry NewsMCLAREN ST. LUKE’S RECEIVES TERMINATION NOTICE FROM PROMEDICA’S PARAMOUNT HEALTH PLANBack To All PostsNewsMclaren St. Luke’s Receives Termination Notice from Promedica’s Paramount Health PlanOCTOBER 22, 2020 – MCLAREN.ORG ProMedica’s Paramount health plan has notified McLaren St. Luke’s of its plans to terminate the hospital’s in-network provider status, effective January 1, 2021. The move would effectively

Industry NewsHELPING PATIENTS AND DOCTORS CONNECT VIRTUALLY, IN MEANINGFUL WAYS.Back To All PostsNewsHelping patients and doctors connect virtually, in meaningful ways.PRODUCT RECOMMENDATION –WWW.MYEMDEE.COMDesigned by doctors, loved by patientsAt Emdee, we’re on a mission to simplify the telemedicine experience, so patients and providers can easily connect in meaningful ways.Our healthcare enhancement app has been designed by physicians,

How to protect our practice’s bottom line from COVID by correctly using new CPT code 99072. ….

Industry NewsRANSOMWARE ACTIVITY TARGETING THE HEALTHCARE/PUBLIC HEALTH SECTOR, WARNS FBI/HHSBack To All PostsNewsRansomware Activity Targeting the Healthcare/Public Health Sector, Warns FBI/HHSThe Cybersecurity and Infrastructure Security Agency (CISA), Federal Bureau of Investigation (FBI), and Department of Health and Human Services (HHS) yesterday warned of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers. This

Industry News DAYTON-AREA PROVIDERS SEEK TO ATTRACT AND KEEP PATIENTS WITH ONLINE SCHEDULINGBack To All PostsNewsDayton-area providers seek to attract and keep patients with online schedulingBY KAITLIN R SCHROEDER – WWW.DAYTONDAILYNEWS.COMThe major health care provider groups in the Dayton-area are hoping online scheduling will help draw in patients who are flocking toward convenience.Kettering Physician Network just

Industry InsightsTELEMEDICINE: The “new normal” in medical billingInsightsTELEMEDICINE: The “new normal” in medical billing…COVID-19 is changing everything today. Healthcare is on the forefront of this pandemic. So much is changing so rapidly and Telemedicine is evolving into a HUGE opportunity for providers of all types and specialties. But how do you care for your patients,

Industry InsightsHBMA RCM Advisor Q4 2019 – President’s MessageInsightsAll Around EngagementPatient engagement is a concept that combines a patient’s knowledge, skills, ability, and willingness to manage their own health and care with interventions designed to increase activation and promote positive patient behavior.*1 Trading “patient” for “attendee,” this is exactly what we saw at this year’s

Industry InsightsHBMA RCM Advisor Q3 2019 – President’s MessageInsightsNavigating the Evolving Topic of Business IntelligenceAs I began in the medical billing field, some of the highest “business intelligence” needed was simply convincing healthcare providers they should change from their antiquated internal system of pegboard accounting and ledger cards to using a billing company that could

Industry InsightsHBMA RCM Advisor Q1 2019 – President’s MessageInsightsStaying on Top of ComplianceOur medical billing and revenue cycle management industry is evolving continually. Our companies must be adding expertise, implementing more technology, generating new ideas, and finding operational efficiencies to keep up with competition, pricing pressure, and ever growing client needs and demands. In such an

Industry InsightsHBMA RCM Advisor Q1 2019 – President’s MessageInsightsFrom Silver to Gold…I am grateful for the opportunity to lead HBMA this year and sincerely appreciate those who have served before me for helping HBMA become the organization it is today. I must also recognize those who serve and have served on the board of directors, as

Industry InsightsHow to Simply Avoid the 2018 MIPS Penalty InsightsHow to Simply Avoid the 2018 MIPS PenaltyEligible Clinicians may have difficulty finding the time and resources to fully participate in the 2018 MIPS reporting year – especially if you are part of a small practice. CMS has made 2018 another “Transition Year” for the new

Industry InsightsMIPS: Individual vs. Group ReportingInsightsMIPS: Individual vs Group Reporting ExplainedThe Quality Payment Program (QPP) allows physicians to choose whether they will participate in the MIPS program as an individual or a group. This is one of the first decisions a practice will need to make when planning their MIPS reporting strategy. The impact of this

On August 3, 2020 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on the proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues, on or after January 1, 2021.

We’ve heard from physicians that they are concerned about the risks involved in reopening their practices. In response to these concerns, we offer the following 10 recommendations:

President Trump is providing support to healthcare providers fighting the COVID-19 pandemic. On March 27, 2020, the President signed the bipartisan CARES Act that provides $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the coronavirus response.

After declining in the first two weeks of the year, flu activity jumped in the week ending Jan. 18, according to the CDC’s most recent Flu View report. Six things to know: 1. The CDC estimates flu has caused 15 million illnesses,140,000 hospitalizations and 8,200 deaths this season.

Texas is now among more than a dozen states that have cracked down on the practice of surprise medical billing.Texas Gov. Greg Abbott, a Republican, signed legislation Friday shielding patients from getting a huge bill when their insurance company and medical provider can’t agree on payment.

One point drew clear agreement Tuesday during a House subcommittee hearing: When it comes to the problem of surprise medical bills, the solution must protect patients —not demand that they be great negotiators.

Surrounded by patients who told horror stories of being stuck with hefty bills, President Donald Trump recently waded into a widespread health care problem for which almost everyone —even those with insurance —is at risk: surprise medical billing.

CMSis delaying for two years implementation of E/Mcoding reforms that affect physician payment, in a move applauded by theAmerican Medical Association.The final 2019 physician fee schedule andquality payment program rule also includes updates on interoperability, telehealth and drug costs.

More than 80,000 Americans died of the flu in the winter of 2017-2018, the highest number in over a decade, federal health officials said last week.Although 90 percent of those deaths were in people over age 65, the flu alsokilled180youngchildrenandteenagers, more than in any other year since the Centers for Disease Control and Prevention began using its current surveillance methods.

Ohio is a step closer to forcing some Medicaid recipients to get jobs if they receive the government assistance.The Ohio Department of Medicaid on Monday said it had officially submitted its request to create the work requirements for those covered through the expansion of Medicaid, the state-federal health insurance program that covers residents with low incomes or disabilities.

Ohio is a step closer to forcing some Medicaid recipients to get jobs if they receive the government assistance.The Ohio Department of Medicaid on Monday said it had officially submitted its request to create the work requirements for those covered through the expansion of Medicaid, the state-federal health insurance program that covers residents with low incomes or disabilities.

The AMA, along with national physician specialty societies, recently sent a letter to the Centers for Medicare & Medicaid Services (CMS) asking that the 2018 Merit-based Incentive Payment System (MIPS) reporting period be reduced from a full calendar year to a minimum of 90 consecutive days. That should happen because of a lack of timely and direct notification about whether a physician is considered MIPS-eligible.

Industry InsightsMIPS: Transition Year vs. Full ReportingInsightsIf you think the new Quality Payment is easy, it may be because we are in the transition year. CMS has made 2017 a transition year to get practices up to speed with the new requirements. This year you only need to report the bare minimum to avoid the

Industry InsightsMIPS: Choosing the Right Quality Measures for Your Practice InsightsNow that we have covered the basics of MIPS (read here), let’s get into the main focus- how to choose the right quality measures for your practice. Even if you do not plan on fully participating this year, you will need to in 2018. Picking

Industry InsightsMIPS: Understanding the BasicsInsightsMIPS: The basics explainedIf you haven’t thought about MACRA yet, the time to start is now. The new Quality Payment Program came into effect January 1, 2017. Let’s start out with the basics…If you see more than 100 Medicare patients or bill more than $30,000 to Medicare a year, you are

It seems like the end of the 2015 PQRS reporting period wasn’t that long ago, with registries concluding their submission process on March 31st. But we are now more than halfway through 2016 with the end of the service year in sight. CMS will begin accepting PQRS submissions after December 31st. With a PQRS registry’s help, practices can start the reporting process and finish their submission any time before the March 31st, 2017 deadline.

If all of the talk about PQRS, MIPS, APMsQRURsand MACRA have you feeling dazed and confused, you are not alone! The healthcare market is abuzz with lots of initials and abbreviations lately and understanding all of these is key to comprehending the physician payment models of the future.

Fifty years ago, Avedis Donabedian, MD, MPH, of the University of Michigan, published his seminal paper, “Evaluating the Quality of Medical Care,” and created a framework that is still used tomeasurehealthcarequality. Donabedian divided quality measures into three categories: structure, processes and outcomes.

Medical Mutual of Ohio said Tuesday it will acquire the 105,000 members in the group and individual health insurance units of HealthSpan Partners.The deal will further consolidate the health insurance industry in Northeast Ohio, where Medical Mutual is already the biggest player. Financial terms of the deal were not disclosed.

What happened in 2015?Things spiked, like the price for a Daraprim pill, which grew 5,000 percent overnight.Things stopped, like low-volume surgeries at three prestigious academic medical centers.Some things exceeded estimates, such as the price of EHR rollouts, while others fell short, such as the acuity of the physician shortage.

Two new polls show mixed results since the Oct. 1 ICD-10 compliance date went into effect. While a survey by consulting firm KPMG found 79 percent of responding healthcare organizations believe thecode transition has been successful to date, a separate survey of doctors by physician social media network SERMO indicates the new billing codes are taking time away from patient care.

ICD-10 will provide an enhanced platform for physician practice. As of October 1, 2015, the ICD-10 coding classification will become the new baseline for clinical data, clinical documentation, claims processing, and public health reporting. Understanding patient encounters and preparing for the transition will be critical to the financial sustainability of each practice.

Aetna will pay $37 billion cash and stock to acquire Humana, the companies announced on July 3, in what will be the biggest health insurance merger to ever hit the industry.“The acquisitionof Humana aligns two great companies,” saidAetnachairman and CEO Mark Bertolini.

WASHINGTON —They are only four words in a 900-page law: “established by the state.”But it is in the ambiguity of those four words in the Affordable Care Act that opponents found a path to challengethe law, all the way to theSupreme Court.

WASHINGTON —Ending years of last-minute fixes, President Barack Obama on Thursday signed legislation permanently changing how Medicare pays doctors, a rare bipartisan achievement by Democrats and Republicans.The bill overhauls a 1997 law that aimed to slow Medicare’s growth by limiting reimbursements to doctors.

These days it’s not just kids who are scared of the doctor: According to a recent Gallup poll, 33% of people say they’ve put off medical treatment because of the price, the highest level in the 14-year historyof the poll. And it’s not only the uninsured who are concerned: 34% of those with private insurance say they are skipping care.

1) Do I really have Medicare?Once you qualify for Medicare, you have the option to choose a Medicare Advantage Plan. They may offer additional benefits that traditional Medicare does not cover; however, it is important to note that these plans are completely separate from each other.

Attending physicians reported losing an average of 48 minutes of free time per clinic day due to EMRs, according to a research letter inJAMA Internal Medicine.The American College of Physicians administered a survey to internists providing ambulatory care regarding how EMRs affect their time budgeting. Final survey results considered 411 respondents.

Four months after President Obama signed into law a one-year delay in the ICD-10 code switchover, the Centers for Medicare and Medicaid Services has announced a final rule establishing October 1, 2015, as the new ICD-10 compliance date.

Did you know that patients with traditional Medicare can contact their insurance to have them forward their claim directly to the patient’s secondary insurance carrier? This is a great advantage to all providers because it reduces the time between when Medicare pays and when the patient’s secondary insurance pays on the balance.

The United States Senate has joined the House of Representatives and passed legislation to prevent a 24% cut in physician fee schedule payments from occurring tomorrow (4/1) as previously scheduled. Instead, Medicare physician fee schedule payments will continue to be paid as they have been for the past 3 months. Although the legislation must be signed by the President in order to become effective, the President has indicated that he will sign this legislation once it reaches his desk.

At one time in America, there was no such thing as “health insurance.” Patients negotiated directly with hospitals and doctors, and paid what they could, often on a sliding scale, according to ability. Eventually, health insurance entered the market, easing the burden of healthcare costs. It didn’t take long to realize the ordinary rules of supply and demand would not apply, if the insurance company, not the patient, was responsible for the bill.

Healthcare.gov has gone live, bringing the Health Insurance Marketplace to the fingertips of millions of Americans. This Marketplace, also known as “The Exchange,” is intended to help bring access to care for the uninsured. As it is still in the early stages of implementation the impact on physician practices is not yet known. What is known is that it is believed that more patients will have access to care than before.

While data shows there’s been an uptick in hospital employment for physicians, more than half still work for themselves, an AMA survey finds. The number of physicians in solo practice, however, has dropped.

It was only a short while ago when a visit to the doctor was a face-to-face conversation. The doctor would ask questions. He wasinterested in what I said. He listened to my responses and wediscussed what to do. Itwas a positiveinteraction.In the last year or two,there’s been a shift. Much of my timewith doctors has been spent watchingthem type.

The Origin-TheRFI is short for Request ForInformation. This report was developed over adecade ago to streamline the communicationbetween NCDS and your office staff when billinginformation is incomplete or additionalinformation is required.

The Origin:SEQUESTRATION –Alegal term referring generally to the act of valuable property being taken into custody by an agent of the court and locked away for safekeeping, usually to prevent the property from being disposed of or abused before a dispute over its ownership can be resolved.

hile solo doctors are hearing from all directions that their independent practices are doomed, not all of them are ready to give up yet. Over the course of 2012, the message that solo physician practices are dead was continually in the news. In July, recruiting firm Merritt Hawkins was ready to put the nail in the coffin of solo practice, saying in its annual review of physician recruiting incentives that recruitment of doctors into solo practice settings was nearly nonexistent.

President Obama’s win in November solidified the direction of healthcare reform in the United States. While the election is over, the healthcare industry is still abuzz with questions as to how Obamacare will be finalized and what impacts to Medicare and Medicaid will be made over the next four years. Not since the Great Society legislation of Lyndon B. Johnson has America seen such monumental reform in healthcare, and the re-election of President Obama means there will likely be more to come.