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1 Min Read

Insurers not paying correctly? Free tool helps address denials

The Claims Workflow Assistant, developed by the AMA, can help your practice understand digital explanations of payment known as electronic remittance advice (ERA) transactions and address any issues with how the insurer handled your claims.

Claims Processing
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2 Min Read

It's official: ICD-10 compliance date now Oct. 1, 2015

Physicians officially have until Oct. 1, 2015, to transition to the ICD-10 code set, according to a final rule issued Thursday by the U.S. Department of Health and Human Services (HHS).

Claims Processing
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2 Min Read

Medicare trustees assume no future SGR payment cuts: Report

In their annual report about the financial future of the program released Monday, the Medicare trustees announced that they will no longer base their budget assumptions on current law calling for physician payment cuts resulting from the sustainable growth rate (SGR) formula, demonstrating a general agreement that it’s time to get rid of the broken formula once and for all.

Medicare & Medicaid
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3 Min Read

Who's leading ACOs: physicians or hospitals?

The first national survey of accountable care organizations (ACO) examines who is playing the strongest leadership and ownership roles in the development of these new models of care.

Payment & Delivery Models
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4 Min Read

8 things you should know about Medicare's proposed payment rule

If the policies set forth in the 2015 Medicare Physician Fee Schedule proposed rule take effect, physicians will be in for a lot of changes—many of them unfavorable—next year. Here are the top eight things that you should know.

Medicare & Medicaid
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2 Min Read

Court considers: Can doctors sue insurers for underpaid claims?

In North Jersey Brain and Spine Center v. Aetna, a physician practice that received assignments of benefits from patients with employer-sponsored health plans sued the insurer for denying and underpaying medically necessary surgeries for three different patients.

Judicial Advocacy
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1 Min Read

Avoid 2016 Medicare penalty: Use a registry for quality reporting

Physicians who don’t successfully report for Medicare’s Physician Quality Reporting System (PQRS) this year will face a 2 percent payment penalty in 2016.

Medicare & Medicaid
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3 Min Read

Doctors tell CMS to put the brakes on new medical staff rules

A final rule revising Medicare’s conditions of participation for hospitals could impact physicians’ role in hospital governance and patient care activities. Under the latest final rule, published in May and scheduled to take effect July 11, a multi-hospital health system would be permitted to have a single, integrated medical staff.

Payment & Delivery Models
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2 Min Read

Panel recommends fixes for Medicare ACO exclusivity problems

New recommendations by the Medicare Payment Advisory Commission seek to correct how the Centers for Medicare & Medicaid Services (CMS) attributes patients to physicians so most doctors will be able to participate in more than one accountable care organization if they so choose.

Payment & Delivery Models