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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
MIPS 2024 Mid-Year Checkpoint: What to Review Before the Second Half of the Year
The 2024 MIPS performance year is half over, the threshold to avoid a penalty is 75 points, and the penalty for missing it is up to 9% of 2026 Medicare Part B payments. Here is the review to finish in July: eligibility, the 180-day Promoting Interoperability window, quality data and the mistakes that cost points.
Change Healthcare Breach Notifications Have Begun: What to Decide Now
Change Healthcare started mailing breach letters on June 20 and posted a substitute notice on its website. OCR has said covered entities may delegate notification to Change, but the obligation stays with you. Here is the decision to make, the clock that runs, the record to keep, and what to tell patients who call.
Medicaid Unwinding Is Ending: How to Stop Losing Visits to Terminated Coverage
Most states have finished or nearly finished their first round of Medicaid renewals, and more than 20 million people have been disenrolled since April 2023, most of them for paperwork reasons. Here is how the losses show up in a practice's denials and the eligibility routine that stops them.
When a Local Hospital System Is in Trouble: Protecting Referrals and Payer Mix
Steward Health Care filed for Chapter 11 on May 6 with 31 hospitals and more than $9 billion in liabilities. For independent practices nearby, a hospital system's collapse changes where patients go, which contracts pay and who answers the phone. Here is how to measure the exposure and protect the practice.
Credentialing a New Practice Location: What Payers Need and How Long It Takes
Opening a second office looks like a real estate problem until the first claims from the new address deny. Here is what each payer type requires when a group adds a location, the order to do it in, the forms involved, a dated example, and the claim holds that keep new-location claims from becoming write-offs.
Ascension's Cyberattack and the Downtime Plan Every Independent Practice Needs
Ascension detected the attack on May 8. Nine days later, orders, results and billing across one of the largest health systems in the country are running on paper. Here is what it means for the practices that refer to Ascension hospitals, and the downtime plan every independent practice should write now.
After the Senate Hearing on Change Healthcare: What Practices Should Do Now
UnitedHealth Group's CEO testified on May 1 about the Change Healthcare attack: a Citrix portal without multifactor authentication, a $22 million ransom, and data on perhaps a third of Americans. Here is what the testimony changes for a practice still reconciling claims, deposits and advances from February and March.
Two Rules in Two Days: HIPAA Reproductive Privacy and the FTC Noncompete Vote
On April 22, 2024, HHS finalized new HIPAA privacy protections for reproductive health information with a December 23 compliance date. On April 23, the FTC voted 3 to 2 to ban most noncompete clauses. Here is what each rule requires, who it reaches, and what a practice should do before summer.
Eligibility Verification Without a Clearinghouse During the Medicaid Unwinding
Eight weeks after the Change Healthcare attack, many practices still cannot run electronic eligibility, and the Medicaid unwinding has disenrolled more than 18 million people, mostly for paperwork reasons. Here is how to verify coverage by hand and work the eligibility denials piling up.
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