HIPAA / ACA / ACO Archives

Coping Medicaid Expansion with Shrewd Medical Billing Practices

The U.S. Department of Health and Human Services (HHS) predicts that the proposed Medicaid expansion will bring an estimated 16 million more Americans into the health-care safety net. The prediction comes even as some twenty-six states are against such expansion. Although the proposed Medicaid expansion would eventually weigh more on the respective states’ budgetary allocation […]

Physicians Strive to Strike a Balance between Managing HIPAA 5010 and Medical Billing

The financial and data-centric nature of the healthcare reforms in the US has left healthcare organizations in all the states of the US to do more data care than healthcare – to manage their finances, maintain data integrity and be complaint with regulatory standards. Health Insurance Portability and Accountability Act (HIPAA) is an example, which, […]

Making physicians’ knowledge transition to ICD-10 and HIPAA 5010 easier, efficient and meaningful

Physicians requiring to upgrading their coding knowledge to a more exhaustive ICD-1O system More than any other clinical or operational entity that needs to realize the affinity to the ICD-10 and HIPAA compliant medical data filing and processing, it is your physicians that require show the lead. As physicians are the first-contact of clinical encounter, […]

Providers preparing for 5010 Enforcement–Medical Billers and Coders need of the hour

Already halfway through the HIPAA Version 5010 noncompliance grace period and in this scenario it is imperative for doctors who still haven’t to utilize the remaining few days to upgrade to 5010, as non compliance of submitting electronic claims in the appropriate 5010 format post 1st April, 2012, will result in the Centers for Medicare […]

States Mimicking Medicare – Experimenting with Accountable Care Models for Medicaid

Accountable Care Organizations (ACO) model’s popularity is growing and mirroring Medicare almost 11 states are trying ACO models for their Medicaid programs by adding initiatives resembling ACO’s to their programs, moreover various providers who initially were vary of Medicare ACO models are showing interest in the state versions as well. With the exact number of […]

Doctors Contemplate Opting Out Due to Continued Medicare Hassles

Physician participating in the Medicare program are scheduled to face a 27.4% cut in their payments, effective 1st January, 2012, and with providers anyway complaining about current reimbursement rates, the cut is likely to considerably impact both patients as well as doctors adversely. As a result of the cut the Medicare physician conversion factor will […]

Physicians to Make the Most of 5010 Enforcement Delay

Physicians were mainly relieved with the announcement made by Centers for Medicare & Medicaid Services (CMS) Office of E-health Standards and Services (OESS) on 17th November, to delay enforcement of Health Insurance Portability and Accountability Act HIPAA 5010 transaction standards with a 90-day discretion period for all HIPAA covered entities. CMS stated that their decision is […]

Strategic Realignment to Affordable Care Organization Model – providers perspective

“While physicians embark on such transformational healthcare model, their quantum of Medicare reimbursement, and its amicable distribution among themselves is sure going to be complex issue. Given such complex calculation on Medicare reimbursements and qualifying incentives, an external medical billing services that is best acquainted with Medicare environment becomes more pronounced.” As time closes in […]

CMS to Delay Enforcing 5010 Compliance

Center of Medicare and Medicaid announced that it will delay enforcing HIPAA 5010 transaction sets requiring hospitals, physician practices, health plans and claims clearinghouses to switch to using the ASC X12 Version 5010 standards for the electronic transmission of healthcare claims and other administrative communications until March 31, 2012 instead on Jan 1,2012 as originally […]

New Analytics Model for Future Fraud and Abuse System

The Center for Medicare and Medicaid services is poised to take bigger steps in preventing fraud and abuse by increasing its monitoring and analytics capabilities. CMS will conduct enrollment and medical claims analytics to keep frauds out of Medicare, for this some necessary technology is already deployed, while the other systems will be ready by […]

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