Reimbursement headaches

Frequently asked questions about differentiating the CMS and AMA code sets.

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.

The Kirksville center's grant comes as Missouri practices rework maternity billing, staffing and pay plans for Jan. 1.

States are limiting AI in coverage decisions. How billing teams can cite the laws on appeal, and why self-funded plans fall outside them.

UnitedHealth says No Surprises Act arbitration awards are its biggest cost pressure. What practices that use IDR should document now.

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.

Only 5 percent of physicians say they have real leverage with payers. Here is what that group does before it ever sits down at the table.

From payer contract homework to a 15-minute morning huddle, these are the moves practice administrators can make after four days of sessions and interviews at MGMA's centennial meeting.