AHA Comment Letter to CMS on the Provider Complaints Submission Process under the No Surprises Act

Published: Tue, 07/05/22

AHA Comment Letter to CMS on the Provider Complaints Submission Process under the No Surprises Act

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — as well as the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) thanks you for the opportunity to comment on the forms providers may use to file complaints with the Centers for Medicare & Medicaid...

Myth or fact? You can’t bill E/M, preventive care from same visit

Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment.

CMS Releases 331 New PCS ICD-10 Codes

The Centers for Medicare & Medicaid Services (CMS) published the ICD-10-PCS codes and guidelines for the 2023 fiscal year on May 26, 2022. These inpatient procedure codes and guidelines will become effective Oct. 1, 2022.

Why You Should Be Using The Two-Midnight Rule

Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has become clear to me that many hospitals are systemically under coding, classifying patients who...

Why physicians are key to successfully navigating payor audits

Just when you think your practice is running without a hitch, it happens. You receive notice of an audit from one or more of your payors, demanding detailed records on one or more of your patients—their beneficiaries. No one welcomes the distraction from clinical care and additional work that an audit requires. That having been said, you need to take these audits seriously, according to AMA Senior Adviser Kathleen Blake, MD, MPH.

Behavioral Health: To Screen or not To Screen?

How to stay compliant in behavioral health screenings. Behavioral health screenings aim to detect mental health symptoms in many seemingly healthy people. This can be done in various ways, including using paper-based instruments in the exam room, computer-based screening in the waiting area, and physician interviews during routine exams. The goal is to apply these screening methods uniformly to patients with potentially undiagnosed mental health problems. Screening and assessment...