The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) initiative is a new model for ACOs operating under Medicare. It will be tested under the Centers for Medicare & Medicaid Services (CMS) Innovation Center’s authority and will adhere to the following priorities: a greater focus on health equity and closing disparities in care; an emphasis on provider-led organizations and...

Medical billing is a process where you pay your provider for their services. When we say you, we mean that this is the process where your insurance carrier and you pay the service provider or hospital you were in for deductible charges.

Following the Furthering Access to Stroke Telemedicine (FAST) Act, Medicare claims for telestroke services increased in rural and urban emergency departments. However, there was still substantial underbilling from hospitals with known telestroke capabilities, according to a Health Affairs study sent to journalists.

Study Rundown: Time spent writing patient documentation in EHR represents a large contributor to physician workload. To reduce this burden and simplify reimbursement, the AMA enacted changes to billing code guidelines for E/M visits starting in 2021. The objective of this study was to evaluate the impact of this guideline change on physician E/M billing practices and EHR use.

A member of a message board I follow, and to which I occasionally contribute, recently posed a question about a denial of coverage based on an alleged failure to meet medical necessity requirements. The admitting diagnosis was metabolic encephalopathy. She did not say (nor, regrettably, did I ask) the principal diagnosis submitted with the claim.