Patient balances after insurance grew 67 percent from 2012 to 2017, and the uninsured rate of working adults ages 19 to 64 also rose 3.3 percent in 2018, making patient collections more challenging than ever. READ MORE
The claim some payers make that the ED is being overused for “non-urgent” conditions is being challenged by reports from the CDC released earlier this year which show that only 5.5 percent of all ED visits are considered non-urgent. READ MORE
Beyond just tracking benchmarks, how can practices use key performance indicators or other financial benchmarks to move the needle toward more effective revenue cycle management? READ MORE
A new bill moving through the California State Assembly, the Health Care Price Relief Act, or Assembly Bill 3087, would form a state-appointed commission to set prices for most healthcare services paid by commercial healthcare. Provider groups worry this is the beginning of a new national trend. READ MORE
The healthcare industry sees anywhere from $11 billion to $54 billion in challenged revenue each year, with claims denial rates as high as 22 percent for traditional fee-for-service Medicaid and 10 percent for insurer-run Medicaid. Here’s what you can do about it. READ MORE
As of March 1, 2018, UnitedHealthcare began using their Optum Emergency Department Claim Analyzer tool to evaluate facility ED claims and then deny or reduce payment for services they deem to be incorrectly coded. READ MORE
Anthem will no longer cover general anesthesia or Monitored Anesthesia Care (MAC) during cataract surgeries, claiming in their recently published clinical guidelines that in most instances it is not medically necessary. READ MORE
In a surprising turn of events, Anthem will not implement a planned new policy to reduce payment for same-day evaluation and management (E/M) services by 25 percent. READ MORE
A new Indiana law passed last April to address the issue of out-of-network surprise billing took effect January 1, 2018. READ MORE
On March 1, 2018, Anthem Blue Cross Blue Shield will begin reducing payment by 25 percent for Evaluation and Management Services performed on the same day as a minor surgery in Indiana, Kentucky, Missouri, Ohio, Wisconsin, and several other states across the country. READ MORE
