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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
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.
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.
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.
Cash Flow During a Payment Interruption: Medicare Advances and Other Options
CMS opened accelerated and advance payments on March 9, 2024 for providers hit by the Change Healthcare outage, and Congress raised the 2024 conversion factor the same day. Here is how the CMS program works, how repayment happens, and the thirteen-week cash plan that carries a practice through the gap.
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.
Preventive Visit or Problem Visit: Same-Day Billing Rules That Hold Up
January and February fill the schedule with annual physicals and wellness visits, and half of them turn into problem visits. Here is how to code both on the same day, what Medicare covers and does not, how to document the split, and how to tell patients before they get a bill.
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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