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by Amanda Ballif
Beginning July 1, 2022, CMS started to enforce applicable price transparency requirements because of the Trump Administration's historic price transparency requirement in 2019 to increase competition and lower healthcare costs for all Americans.
by Amanda Ballif
The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.
by SAMSHA Newsroom
New Resources to Help People Seeking Care to Understand and Access Protections Offered Under the Parity Law for Mental Health and Substance Use Disorder Benefits
by Wyn Staheli, Director of Content - innoviHealth
The question "Does my insurance cover chiropractic care" is the ongoing question chiropractic offices have struggled with for years. Unfortunately, when it comes to insurance, coverage often varies between payers — even varying between plans for a single payer so there isn't one easy answer.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial.
As any company who has billed Medicare services can attest, the one-year timely filing ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...
Mar 1st, 2019
Understanding NCCI Edits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
Dec 26th, 2017
CHIP Reauthorization for 2018
by Jared Staheli, MPP
The authorization for the Children's Health Insurance Program (CHIP) funding expired at the end of September 2017. The aim of the program is to fund health insurance for children in families who make too much to qualify for Medicaid but cannot afford private insurance. Without reauthorization, 9 million children are ...
Nov 28th, 2017
Medicare Expands Value Based Plans
by Wyn Staheli, Director of Content - innoviHealth
In 2015, the CMS Innovation Center announced plans for new value-based Medicare Advantage plans in an effort to reduce healthcare costs while improving quality of care. This five year pilot program began in 2017 with seven states and is expanding to ten states for 2018. Results must have been positive because they ...
Aug 4th, 2017
Veterans Choice Program
by Wyn Staheli, Director of Content - innoviHealth
In 2017, President Trump signed into law changes to the Veteran's Choice program, which allows veterans to seek care from a civilian (privately contracted) healthcare provider, closer to home, when obtaining care through the VA has become burdensome to the veteran or requires the veteran to wait too long for an appointment.
Jun 28th, 2017
Medicare Announces New Cards to Be Issued
by Mario Fucinari, DC CCSP CPCO MCS-P MCS-I
Identity theft has become a major problem in the United States. As a prevention measure, the Centers for Medicare& Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars.
by Brandy Brimhall, CPC CMCO CPCO CCCPC CPMA QCC
We have been leaving box 14 on the 1500 claim form blank for Medicare claims and are getting denials. Could this be why?
Jan 13th, 2017
Whiplash Damages
by ChiroCode™
Whiplash Damages in Rear-end Collisions - The Patient’s Dilemma:
The rear-end collision is a major cause of cervical spine injuries which often require treatment by chiropractors and other health care practitioners. Claims adjusters trivialize soft tissue injuries [it’s “only” a sprain or strain] but whiplash is real and so are the damages that come with it.
Dec 7th, 2016
Discounts
by Wyn Staheli, Director of Content - innoviHealth
All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing either Chapter 1.5-Fees of the Behavioral Health DeskBook or the Insurance and Reimbursement chapter ...
Sep 17th, 2016
Consumer Directed Health Plans (CDHP)
by Wyn Staheli, Director of Content - innoviHealth
Consumer Directed Healthcare Plans (CDHP) were developed as a way to shift the control of healthcare dollars from the insurance companies to the patient (consumer). The goal of these types of plans is to allow the patient to take a more active role in their own health and healthcare decisions ...
Sep 17th, 2016
Government Healthcare Programs
by Wyn Staheli, Director of Content - innoviHealth
The Department of Health and Human Services (HHS) oversees all government health care programs. They are administered by various agencies such as the Centers for Medicare & Medicaid Services (CMS), the Veterans Administration (VA) and even at the state level. Here are the basic government programs:
Medicare
Federal Workers’ Compensation
Military and Veterans
Medicaid
Federal ...
by Wyn Staheli, Director of Content - innoviHealth
High-deductible plans are changing the way patients utilize medical services, therefore, providers must also adapt by adjusting both their communication and billing practices to keep pace with these changes.
Mar 4th, 2016
What is an 'Other Qualified Healthcare Professional'?
by Wyn Staheli, Director of Content - innoviHealth
What's the difference between a physician, an other qualified healthcare professional, clinical staff and individual.
Dec 11th, 2015
The Benefit of Checking Benefits
by Fabrienne Castro
Many of your physicians perform surgeries and diagnostic procedures on patients. It is easy to call and determine if precertification is required, but how many of you actually look at what is required of a patient prior to performing the procedure? In many cases outpatient procedures...
Sep 11th, 2015
Essential Health Benefits (EHBs)
by Wyn Staheli, Director of Content - innoviHealth
Information about the mandated Essential Health Benefits (EHBs). Includes links and other helpful information.
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