Healthcare Law Insights blog

MARCH 12, 2024

Therefore, on August 3, 2023, the Departments of Labor, Health and Human Services, and Treasury (collectively the “Departments”) released a comprehensive proposed rule to the Mental Health Parity and Addiction Equity Act (“MHPAEA”). [5] The 2023 Proposed Rule is comprehensive. 4 2023), [link]. [5] 3, 2023). [6]

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Documentation Insurance Medication 64

Valant

JULY 29, 2024

This code is acceptable to insurers when used to describe a marked change in mental health status not attributable to other factors. Check out the 2023 ICD-10 updates here. Altered mental status, unspecified (R41.82) is a billable ICD-10 diagnostic code under HIPAA regulations from October 1, 2020, to September 30, 2021.

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Diagnostics HIPAA Insurance Medication 97

The Healthcare Blog

APRIL 2, 2024

billion (or 60% of its total revenues) represent clinical and business services provided to United’s Health Insurance business. Source: 2023 UNH 10K For most of the past decade, Optum has been driving force of incremental profit growth for United. billion in 2023 (55% of total). in the third quarter of 2023.

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Tests Hospital Insurance Medication 132

Healthcare Law Insights blog

JULY 7, 2023

A handful of FCA circuit court decisions issued in 2023 are noteworthy as well. Importantly, although the court assumed the relator engaged in some protected activity, the court found that in many of her communications she, at most, characterized discrepancies in therapy documentation as mistakes or possible computer glitches, not fraud.

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Transfers Hospital Documentation Communication 52

Health Prime

JUNE 22, 2023

According to a recent Precedence Research report , the gastroenterology market size 2023 is USD 54.56 Accurate gastroenterology coding and documentation Accurate coding and thorough documentation are the foundation of successful medical billing. billion, expected to grow to USD 93.8 Billion by 2032.

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Best Practices Billing Medication Documentation 52

The Healthcare Blog

MARCH 13, 2024

Many patients must contend with well-documented side effects such as nausea, diarrhea or the significant loss of lean body mass (ie. muscle) and bone density. Again, those are lifetime side effects. and some patients simply tire of giving themselves a weekly injection.

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Documentation Insurance Patient Care Medication 96

ACMA Blog

OCTOBER 8, 2024

Their knowledge of insurance coverage, regulations in patient assistance, and health policy empowers healthcare providers with tools that reduce hurdles in treatment access. Disrupted care was measured as a share of physicians who “reported that patients abandon treatment due to authorization struggles with health insurers”.

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Documentation Medication Billing Follow-Up 52

ACMA Blog

JUNE 25, 2024

It is the insurance or payers’ way of controlling costs by approving or denying certain medications, procedures, or devices that may not usually be covered or is on a higher tier on the formulary. Clinical Documentation Specialist (CDS): A CDS can help in the PA process by accurately documenting patient records.

Documentation 40

Documentation Medical Assistant Certification Insurance 40

Pulmonology Advisor - Practice Management

MAY 3, 2024

In 2023, a new analysis of medical malpractice claims against US physicians was released by the American Medical Association (AMA). Dr P was shocked when he subsequently was served with legal documents notifying him that he was being sued for medical malpractice based on his alleged failure to properly treat Mr L.

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Medication Hospital Huddles/Rounds Documentation 98

Healthcare Law Insights blog

NOVEMBER 21, 2023

The good news for administrators is that they are permitted to submit affidavits or other documents from outside the administrative record that show that the conflict of interest played no role in the decision-making. A documented history of arbitrary claims denials by the administrator. Reliance Standard Life Insurance Co. ,

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Documentation Follow-Up Medication Insurance 52

ACMA Blog

OCTOBER 16, 2023

It is the insurance or payers’ way of controlling costs by approving or denying certain medications, procedures, or devices that may not usually be covered or is on a higher tier on the formulary. Clinical Documentation Specialist (CDS) : A CDS can help in the PA process by accurately documenting patient records.

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Medical Assistant Documentation Certification Communication 40

Health Prime

JUNE 22, 2023

According to a recent Precedence Research report , the gastroenterology market size 2023 is USD 54.56 Accurate gastroenterology coding and documentation Accurate coding and thorough documentation are the foundation of successful medical billing. billion, expected to grow to USD 93.8 Billion by 2032.

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Best Practices Billing Medication Documentation 40

Healthcare Law Insights blog

AUGUST 28, 2023

4] From court documents, it appears the government argued that Dr. Elfenbein knew that the patients whose insurance would be billed for E/M services would be with physicians “less than five minutes,” [5] and that Dr. Elfenbein told employees that E/M services were “the ‘bread and butter’ of how we get paid.” [6] 11, 2023). [4]

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Billing Tests Documentation Insurance 52

ACMA Blog

OCTOBER 8, 2024

Many healthcare providers may prescribe treatments that are not considered routine or may be expensive, an insurance company may need prior authorization (PA) to determine whether they will cover what the healthcare providers recommends 4. The healthcare provider must get approval from the insurance company.

Medication 40

Medication Insurance Documentation Follow-Up 40

Relias

JUNE 1, 2023

More technology is not always the best solution In a recent healthcare provider survey , half of healthcare executives said the revenue cycle is a top priority for software investment in 2023. 5 – Educate clinicians on required documentation Clinicians sometimes omit important documentation.

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Documentation Admissions Follow-Up Scheduling 52

Relias

JUNE 1, 2023

More technology is not always the best solution In a recent healthcare provider survey , half of healthcare executives said the revenue cycle is a top priority for software investment in 2023. 5 – Educate clinicians on required documentation Clinicians sometimes omit important documentation.

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Documentation Admissions Follow-Up Scheduling 52

Relias

FEBRUARY 1, 2023

It will be imperative for medical practices and organizations to focus on their billing and denial management to maximize revenue in 2023,” noted Cristy Good, MPH, MA, senior industry advisory and coding expert at MGMA. Some insurance companies have a list of “preferred” infusion drugs and won’t pay for other drugs.

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Insurance Billing Documentation Hospital 10

Relias

APRIL 27, 2023

Better retention As many as 58% of medical practices said that staffing is their biggest challenge for 2023, according to an MGMA Stat poll. Top 10 healthcare revenue cycle training priorities with the best ROI What training topics are the most important for the healthcare revenue cycle in 2023? It’s hard even for experts to keep up.

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Critical Thinking Follow-Up Billing Best Practices 52

ACI Medical & Dental School

OCTOBER 24, 2023

ACI Medical & Dental School Prepares Students for In Demand Healthcare Jobs ( Updated for 2023 ) The National Healthcareer Association (NHA) has released their 2023 Industry Outlook , which continues to show that jobs for allied health professionals in the US are growing at 13%, a much faster rate than other professions.

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Medical Administrative Assistant Medical Assistant Certification Continuing Education 52

Minority Nurse

NOVEMBER 22, 2023

Shelise Valentine, RNC, MSN, C-EFM, CPPS, CPHRM, is the Director of Clinical Education, Healthcare Risk Advisors, part of TDC Group and chairs nursing, co-chairs obstetric and simulation initiatives, and directs risk management and obstetric education for insured hospital clients to improve patient safety and reduce malpractice risk.

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Unit Organization and Environment Patient Safety Best Practices Hospital 59

CareerStep

NOVEMBER 14, 2023

The American Medical Association (AMA) reported that as of spring of 2023, the U.S. They’re used for billing and insurance reasons. Think of it as a simplified language for a patient’s medical history, because every doctor and insurance company in the U.S But, what do medical coders and billers do?

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Billing Medical Coding Medication Certification 52

ACMA Blog

MAY 21, 2024

Through enhanced coding and charge capture, these algorithms analyze clinical documentation to propose precise medical codes, minimizing the risk of undercoding or overcoding while ensuring comprehensive coverage of billable services. Published April 3, 2023. www.revelemd.com. Accessed April 9, 2024. link] Jongsma KR, Sand M, Milota M.

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Billing Documentation Patient Satisfaction Patient Experience 40

Arkenea

AUGUST 16, 2024

HCA Healthcare In July 2023, a Tennessee hospital and clinic operator was breached by threat actors who obtained and removed data from an external storage location containing formatted emails and calendar reminders for patients. Examples of Healthcare Cyberattacks 1. Maintaining patient confidentiality is just as important.

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HIPAA Patient Records Medical History Clinical Operations 52

Pulmonology Advisor - Practice Management

OCTOBER 13, 2023

The 2023 Medscape survey found that plastic surgery is now the happiest specialty, with 71% of physicians reporting they are “very happy” or “happy” outside of work. Striking a Work-Life Balance The 2023 Medscape Physician Lifestyle and Happiness Report also asked physicians, “How are you maintaining your happiness and mental health?”

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Follow-Up Scheduling Medication Hospital 52

Ciox

NOVEMBER 20, 2023

The Impact Health plan policies are changing more frequently, forcing healthcare organizations to defend their documentation when denials occur. Denial Rates : In the first quarter of 2023, 15% of commercial claims were initially denied. This trend is not expected to change in 2024.

Documentation 40

Documentation Insurance 40

Pulmonology Advisor - Practice Management

MAY 3, 2024

In 2023, a new analysis of medical malpractice claims against US physicians was released by the American Medical Association (AMA). Dr P was shocked when he subsequently was served with legal documents notifying him that he was being sued for medical malpractice based on his alleged failure to properly treat Mr L.

Medication 52

Medication Hospital Huddles/Rounds Documentation 52

Arkenea

AUGUST 15, 2024

HCA Healthcare In July 2023, a Tennessee hospital and clinic operator was breached by threat actors who obtained and removed data from an external storage location containing formatted emails and calendar reminders for patients. Examples of Healthcare Cyberattacks 1. Maintaining patient confidentiality is just as important.

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HIPAA Patient Records Medical History Clinical Operations 40

The HIPAA Journal

MAY 1, 2024

The forensic investigation and document review confirmed that the protected health information of more than 623,000 patients had been exposed. One of those lawsuits, Bonnie Maser v.

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HIPAA Documentation Insurance Medication 100

Arkenea

OCTOBER 10, 2024

In 2023, 725 data breaches were reported to OCR and across those breaches, more than 133 million records were exposed or impermissibly disclosed. Incorporation of privacy measures such as HIPAA (Health Insurance Portability and Accountability Act) compliance can safeguard healthcare data against potential cyber-attacks.

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HIPAA Tests Transfers Patient Satisfaction 52

Relias

JULY 20, 2023

Maternal mortality is closely linked to social and behavioral factors As documented extensively, higher U.S. Managing gaps in mental health services by expanding the scope of services offered, increasing training on mental health for all staff, and reviewing documentation practices can also help.

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Hospital Documentation Discharges Best Practices 40

Sensible Medicine

DECEMBER 5, 2024

Reasonable persons could argue about the weight of the effects of pharmaceutical and insurance companies on the average American's health and the effects on the medical profession, but his assertions have validity. Corporate influence in medicine has significant negative effects.

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Medication Huddles/Rounds Documentation Billing 99

The HIPAA Journal

APRIL 23, 2024

After listening to feedback from healthcare providers, privacy advocates, and individuals, OCR proposed HIPAA updates in April 2023 to modify the HIPAA Privacy Rule to address the changes to the legal landscape in response to the fall of Roe v.

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HIPAA Follow-Up Patient Records Medication 90

Sensible Medicine

NOVEMBER 21, 2024

Here is a prime example: As journalist Jesse Singal has documented , the trans activist Andrea James publishes a defamatory page on her web site of any public figure, no matter how remote, who speaks with even a remotely critical voice about pediatric gender medicine. Subpoenaed internal records have proved this. years old or younger.

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