Practical knowledge from people who do the work.
Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
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.
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.
Switching Clearinghouses After the Outage: How to Do It, and When Not To
Change Healthcare began reconnecting its claims network the week of March 18, and practices are now deciding whether to switch back, stay with a new vendor or run both. Here is what a clean clearinghouse migration involves, the enrollment steps that take the longest, and the cases where switching is the wrong call.
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.
How to Build a Claims Contingency Plan for a Clearinghouse Outage
A week into the Change Healthcare outage, most practices are discovering they have no plan for a clearinghouse failure. Here is how to write one: the dependency map, a second submission route, eligibility and remittance fallbacks, the cash reserve and the daily count that keeps claims from aging out.
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.
MIPS 2024: What Changed and What Small Practices Should Set Up Now
The 2024 MIPS year keeps the 75-point threshold but raises data completeness to 75 percent, extends the Promoting Interoperability period to 180 days and adds four MVPs. Here is what each change means for a small practice, plus the decisions to make before the end of March.
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