Billing and Collections

CMS has announced a follow-up Special Open Door Forum conference call on Sept. 26 on the "two midnights" benchmark. It's intended to allow hospitals and other providers to ask questions on the FY14 physician order and physician certification, inpatient hospital admission and medical review criteria in the IPPS/LTCH final rule.

Managing denials is a challenging prospect for providers, but experts say there are steps to make the process more efficient and more likely to be successful.

In advance of its annual conference, held this week in Las Vegas, the Healthcare Billing & Management Association talked to HFN about critical issues facing the medical billing industry.

According to a revenue cycle management study released by market researcher Black Book, 72 percent of physician practices expect declining to negative profitability next year because of underutilized or inefficient billing technology.

With implementation of the Affordable Care Act fast approaching, the eligibility process could be queuing up for an overhaul.

The Centers for Medicare & Medicaid Services has recommended that hospitals start testing for ICD-10 in 2013, but so far, many have not heeded that recommendation. That mistake could ultimately hit hospitals in the wallet.

Federal agents seized up to $2.6 million in fraud proceeds from various bank accounts held by the Chicago-based firm, which specializes in physician house calls across six states. The company is accused of upcoding Medicare bills for in-home patient visits.

Without question, the recently reported one-year grace period granted to some insurers for out-of-pocket expenses will have a serious effect on the financial health of both patients and hospitals.

Florida's Shands Healthcare has agreed to pay $26 million to settle overbilling allegations.

Several key trends are reshaping the business strategies of health insurers in advance of the Jan. 1 go-live date for many provisions of the Affordable Care Act.