States are limiting AI in coverage decisions. How billing teams can cite the laws on appeal, and why self-funded plans fall outside them.
|Articles|March 7, 2017
Healthcare Policy Talk Leaves Patients Two Options
Author(s)Jon Carter
Are you getting anxious, just hearing the discussions surrounding the Affordable Care Act? This doctor has two options for you.
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The survey revives a stalled bill that would end the physician agreements practices maintain for the nurse practitioners they employ.
The CMS-0057 rule regulates health plans, not practices, but administrators are the ones who have to get the EHR and billing vendor conversations right.
Most Medicaid improper payments trace to missing paperwork, not fraud. These nine checks close the gaps auditors keep finding.
Payers deny with AI while practices appeal by hand. Taya Gordon on retiring 30-day AR buckets, the benchmarks to watch and a quick downcoding check.
An IDR win isn't a check. Payers have 30 days to pay, courts won't force them to and CMS admits awards are slipping through.
A Utah program allows Nolla Health's AI to prescribe acne treatment within physician-approved limits. Physician review scales back as more patients enroll.
Madison Hynes of MGMA explained what practice leaders should watch as electronic prior authorization and Medicaid work requirements arrive Jan. 1.
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