icd10In the next eMDs Insights Blog Series, we will be exploring the specifics of ICD-10-CM.  In this first post, we will start at the top - how the ICD-10 is organized and structured.  In future posts, we will explore the specific differences between ICD-9-CM and ICD-10 CM for the most common codes by specialty.  In order to maintain consistency with and adherence to CMS published policy, we will u

hackedAnthem, one of the nation’s largest health insurers, announced late last Wednesday that the personal information of tens of millions of its customers and employees was exposed in a “very sophisticated external cyberattack.”  Anthem operates health plans under numerous brands, including Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross

auditLast December, CMS announced an extension of their RAC (Recovery Audit Contractors) contracts with the same four companies that have managed the program the last few years.

docatdeskBCBSNJ Changes Members’ Medicare Plans

New Jersey BCBS has made changes to their Medicare population plans in 2015, terminating their Horizon Medicare TotalCare plan and introducing a new patient-centered Medicare Advantage plan.

Horizon Medicare Blue TotalCare is Discontinued

BCBSAnthem BCBS of Connecticut, Indiana, Ohio, New Hampshire and Empire BCBS of New York are working with OrthoNet, LLC to process precertification requests and conduct post service prepayment coding reviews of professional services for their Medicare Advantage members. This program began on January 1, 2015 and is for professional claims only. Facility claims are excluded.

modifier59Many private payors have announced they will use the new 59 (Distinct Procedural Service) modifier subsets released by CMS this past summer. The four modifiers, collectively know as the  X(EPSU) modifiers, will be effective for most carriers on January 1, 2015.

compliance So now you have done the hard work of obtaining, evaluating and negotiating the contracts with your payors, it is now an important part of your day-to-day revenue cycle processes to ensure that they are honoring the terms of these contracts.

CMSThe Centers for Medicare & Medicaid Services (CMS) is pursuing additional rule-making potentially leading to reduced meaningful use requirements in 2015, one of which is a 90-day rather than a full-year reporting period, according to the federal agency’s blog.

Doctor with PatientAccording to Medscape's Physician Lifestyle Report, physicians are burned out and only getting more so.  And the most important cause of burnout - bureaucracy and spending too much time at work on administrative tasks.

manvslamppost Click to view Infographic.