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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
Change Healthcare Breach Reaches 100 Million: What Practices Owe and Should Ask
Change Healthcare told federal regulators on October 22, 2024 that about 100 million breach notices have gone out, the largest healthcare breach ever reported. Here is where a practice's HIPAA obligations stand, what the notification delegation means, and the questions to put to every vendor that touches your claims.
UnitedHealthcare's Gold Card Started October 1: Who Qualifies and What Changes
UnitedHealthcare launched a national Gold Card program on October 1, 2024 that waives prior authorization for qualifying groups on selected codes. Here is how eligibility works at the TIN level, why "no prior auth" still means an advance notification, and how to check and protect your status.
UnitedHealthcare's Gold Card Program: Tracking Prior Authorizations to Qualify
UnitedHealthcare announced a national Gold Card program on August 1, effective October 1, 2024, that exempts qualifying groups from prior authorization on selected codes. Qualifying depends on a two-year approval rate the payer calculates. What it requires, how the math works, and the tracking that gets you there.
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.
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.
The 2025 Medicare Advantage Rate Announcement: What It Means for Practices
CMS finalized 2025 Medicare Advantage payment rates on April 1, 2024, with a 3.7 percent average increase and the second year of the new risk adjustment model. Plans call it a cut. Here is what actually changed, how it reaches your practice through documentation requests and contract terms, and what to watch for.
HHS Weighs In on the Change Healthcare Outage: Paper Claims and Funding
On March 5, 2024, HHS issued its first formal statement on the Change Healthcare cyberattack: Medicare contractors will accept paper claims and speed up EDI enrollment, and payers are urged to relax prior authorization and timely filing. Here is what each measure means, and what the UnitedHealth funding program covers.
Change Healthcare Is Down: What We Know on Day Three and What to Do Now
Since February 21, 2024, Change Healthcare has disconnected its systems after a cyberattack, taking claims, eligibility, remittance and pharmacy transactions offline for a large share of U.S. practices. Here is what has been confirmed, what has not, and the first steps to protect cash flow.
The 2023 CAQH Index: What Manual Transactions Cost a Small Practice
CAQH released its eleventh Index on January 30, 2024. Administrative spending on the nine tracked transactions rose sharply, and prior authorization is still mostly manual. Here is how to read the report from a practice's side of the desk and which transactions are worth automating first.
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