The passage of the Affordable Care Act empowered CMS to encourage new payment models by changing reimbursement structures driving an evolution from pay for volume to pay for outcome.

If you thought it was difficult for your practice to field patient questions that start with “Do you accept?” in the past, health exchange plans have just made it more difficult to answer. Each plan participating in a state exchange has identified or created a network to service members and they vary widely. Look at the exchanges as another plan type as you would Medicare Advantage or a Managed Medicaid and improve the patient experience by having information available to answer their questions.

After years of pressure from consumer groups and new outlets, and with the AMA court injunction lifted, the Center for Medicare Services released data this week on what Medicare paid individual doctors in 2012. The historical release of data is the first time this information has been available to the public since the 1970s. It represents the first step in the Obama Administration’s efforts to make our health system more transparent, accountable and affordable.

Bundled payment programs have gotten much less attention than Medicare ACOs and commercial global capitation programs, but they offer an attractive risk and care management option that is designed more for specialists than for PCPs.  Typically bundled payment programs are initiated by a discrete clinical diagnosis or event, and cover all necessary care for a pre-determined period of time.  For example, the Medicare BPCI demonstration is initiated by a hospital admission and includes all medical services required for 30, 60, or 90 days post discharge, depending on the preference of the parti

Under the Protecting Access to Medicare Act of 2014 (the Act), Congress adopted a substantially different pathway for setting payments under the Medicare Clinical Laboratory Fee Schedule (CLFS). These reforms are intended to modernize the CLFS by moving away from a payment system based upon historical charge data that are now nearly 30 years old and moving to a market-based payment system intended to provide accurate, transparent and timely rate-setting determinations for clinical laboratory services.

Aetna LogoAetna is changing the standard method of reimbursing providers from Paper checks to Electronic Funds Transfer (EFT). All providers are required to enroll in EFT. This change is applicable to Medical and Dental providers.

CongressUPDATE: SGR repeal, ICD-10 delay legislation passes in the House After this morning’s postponement of proceedings concerning HR 4302 (Protecting Access to Medicare Act of 2014), the House of Representatives reconvened to consider unfinished business and a voice vote in favor of passing the patch for the Sustainable Growth

CongressAs part of new legislation implementation of ICD-10 could be delayed until no sooner than Oct. 1, 2015. Section 212 of the bill states that the Secretary of the U.S.

Joy B. Hicks, CPM, has worked in the healthcare industry since 2001, in medical billing, collections, and patient accounting. Her number one goal is to create a positive impression of the healthcare industry by promoting quality customer service.  As a medical office expert, Joy evaluates and analyzes opportunities for improvement within the medical office in order to provide proven strategies that improve work efficiency, increase revenue, and provides staff education and training, among other things.