Claims Processing
One of the major arguments against the ICD-10 transition are the financial costs to medical practices. Sure, there are accusations of bureaucratic overreach, but the anti-ICD-10 argument is primarily financial. So why not offer providers an incentive?
For the second year in a row, Humana ranked first in overall performance among 148 payers, according to the 2014 PayerView Report. The report ranks health insurers according to specific measures of financial, administrative and transactional performance.
The federal government and a number of hospitals may want to transition to a new Medicare reimbursement model. But there are still billions of dollars in disputed fee-for-service claims waiting to be settled, sowing animosity between health systems and the feds.
A new interpretation of a 40-year-old law could offer healthcare providers more options for appealing payer recoupments or preventing them altogether.
On Oct. 1, 2013, I marked the 12-month countdown to ICD-10 implementation by attempting to answer some basic questions. Now that more than six months have passed, and we have another deadline delay, many healthcare providers still can't get satisfactory answers.
With Medicare's "two midnight rule" set to take effect later this year and audit appeals facing lengthy backlogs, the Recovery Audit Contractor program may be headed in some new directions.
An unusual 90-day grace period for government-subsidized health plans may leave physicians at risk for not getting paid for their services.
The financial impact of the two midnights rule remains an open question and so is whether recovery auditors will challenge fewer claims or just shift their focus.
It has never been clearer: physician practices must be able to code in ICD-10 to bill for services and procedures after Oct. 1, 2014, or they will see a cash flow interruption, additional costs and delayed claims payments. But payers, clearinghouses and vendors can help you.
Despite the hassle of auto-cancellations, many home healthcare agencies find it difficult to keep track of their requests for anticipated payment.