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Tag Archives: health

Health Plan Data Unlocks Population Health Improvements

Health Leaders Media

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  January 27, 2016 Follow us on FacebookFollow us on TwitterJoin us on LinkedInRSS feed

Health Plan Data Unlocks Population Health Improvements

Rene Letourneau, Senior Editor for HealthLeaders Media

By analyzing claims data, Milwaukee-based Children’s Hospital has measurably increased immunization rates and boosted care delivery and outcomes for some of the city’s most vulnerable citizens. >>>


Editor’s Picks

3 Ways Telemedicine is Changing Healthcare

From increasing access to influencing better patient outcomes, health systems are recognizing the benefits of virtual patient visits and remote monitoring—and finding ways to mitigate the costs. >>>

Population Health Really Does Work

At self-insured Houston Methodist, a population health pilot designed for staff members saw 50% of high-risk participants move into the low-risk pool within the first six months. >>>

Workarounds in Hospitals Raise Ethical Questions

A disconnect between how an organization imagines work is happening and what staff feel they must do puts healthcare workers on potentially ethically shaky ground. >>>

Postacute Strategies Vary Widely, Lack Standards

Two studies point to the need for a more thoughtful approach to postacute care strategies because readmission rates are simply not improving for some patients. >>>

How Public / Private Accelerators are Fostering eHealth Innovation

It is no surprise that a growing number of healthcare institutions are seeking partnerships to fund and nourish innovative startups. Massachusetts and New York are at the forefront of fostering such relationships. >>>

Readmission-reducing RED Protocol Adoption Lagging

The creators of the 12-step Re-Engineered Discharge protocol say it saves money, but hasn’t yet been widely or fully adopted. Follow-up studies have shown that problems arise when RED is diluted. >>>

Bringing the Healthcare Quality Message to the Masses

A documentary film honoring the AHRQ and the late John Eisenberg, a health systems research pioneer, also aims to promote health policy and patient safety, says his son, the filmmaker. From MedPage Today. >>>

Intelligence Report

Intelligence Report: The Outpatient Opportunity—Expanding Access, Relationships, and Revenue

In this HealthLeaders Media research report, the reasons behind ambulatory and outpatient care expansion may originate from different strategic points of view, but the tactics and objectives have much in common.
Order Today >>>

News Headlines

Trump calls for Medicare to negotiate drug prices

The Hill, January 27, 2016

Has Obamacare’s Medicaid expansion reached a tipping point?

CNBC, January 27, 2016

Medica, Blue Cross notch big growth in public insurance

Star Tribune, January 27, 2016

Health insurer Centene missing data drives with client information

Reuters, January 26, 2016

CBO lowers estimated Obamacare sign-ups by 40%

The Hill, January 26, 2016

Fidelity moves deeper into healthcare space with new exchange

Boston Business Journal, January 26, 2016

Deficiencies found at Theranos lab

The Wall Street Journal, January 25, 2016

Drug shortages in American ERs have increased more than 400%

Chicago Tribune, January 25, 2016

Law keeps ID health insurance CEO’s salaries secret / Associated Press, January 25, 2016

Broward Health CEO kills himself, sheriff’s office says

Sun Sentinel, January 25, 2016

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Our award-winning Daily News & Analysis e-newsletter can keep your leadership team abreast of relevant breaking news, and with in-depth industry coverage through 10 weekly e-newsletters that hit every pillar of healthcare, we’ve got your whole leadership team covered. Subscribe to any — or all — of our e-newsletters.


Webcast: Building Reputation, Managing Risk—ProMedica’s Model

Date: February 9, 2016, 1:00–2:00 p.m. ET
In this expert webcast, learn how establishing a proactive program to build reputation capital, manage reputational risk, and create a collaborative connection will better prepare providers for dealing with crises in the future.
Register Today >>>

From HealthLeaders Magazine

Big Ideas

What big ideas have you enacted? What big opportunities await your organization? >>>


Ups and Downs of High Volume


Remaking the Board

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Home Health Care: Proper Certification Required

Originally Published on

The Affordable Care Act requires a physician or a non-physician practitioner to have a face-to-face encounter with the beneficiary before a physician certifies the beneficiary’s eligibility for the home health benefit. One aspect of the certification is for the certifying physician to certify (attest) that the face-to-face encounter occurred and document the date of the encounter. For medical review purposes, Medicare requires documentation in the certifying physician’s medical records and/or the acute/post-acute care facility’s medical records to be used as the basis for certification of patient eligibility. This documentation must include the clinical note or discharge summary for the face-to-face encounter. Avoid home health claims payment denials or improper payment recoveries by understanding Medicare’s requirements.




MLN Matters® Articles:

The Medical Management Institute – MMI – Medical Coding News & MMI Updates

University of Missouri settles health care fraud claim

Settling a claim that their health care program committed fraud, the University of Missouri has agreed to pay the United States government $ 2.2 million. The program had been accused of violations of the False Claims Act by submitting many claims for their radiology services to various federal programs (such as Medicare and Medicaid), and also for maintaining that radiology images had receive physician review.

You can read the full article here:

The post University of Missouri settles health care fraud claim appeared first on The Coding Network.

The Coding Network

Payment for G0101 and Q0091 in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

The Centers for Medicare & Medicaid Services (CMS) has determined that HCPCS codes G0101 (Cervical or vaginal cancer screening; pelvic and clinical breast examination) and Q0091 (screening Papanicolaou smear) are billable visits when furnished by a RHC or FQHC practitioner to a RHC or FQHC patient.

CR8927 instructs MACs to allow HCPCS codes G0101 and Q0091 to be billed as a standalone encounter/visit. These services will be paid the AIR on RHC and FQHC claims for 71X and 77X Types of Bills (TOBs), effective for dates of service on or after January 1, 2014. Please note that deductible and coinsurance are NOT to be applied to G0101 or Q0091. If other billable visits are furnished on the same day as G0101 or Q0091, only one visit will be paid.

G0101 or Q0091 are payable annually for women at high risk for developing cervical or vaginal cancer, and women of childbearing age who have had an abnormal Pap test within the past 3 years. It is payable every 2 years for women at normal risk. For FQHCs billing under the PPS, G0101 and Q0091 are qualifying visits when billed with FQHC payment HCPCS codes G0466 or G0467.

Please note: MAC will not search for claims that have been denied with HCPCS code G0101 or Q0091 prior to the implementation of CR8927, but will adjust any claims that you bring to their attention.


Coding Ahead

[Home Health] New Program for Evaluating Payment Patterns Electronic Report (PEPPER) Available

A new Program for Evaluating Payment Patterns Electronic Report (PEPPER) for Home Health Agencies (HHAs) is available through the PEPPER Resources Portal. CMS contracts with TMF to produce and distribute these free reports that summarize HHA claims data statistics for areas that may be at risk for improper Medicare payments. HHAs can use the data to support internal auditing and monitoring activities. Compare your Medicare billing practices with other HHAs in the nation, Medicare Administrative Contractor jurisdiction, and state.

The report includes:

• Average case mix
• Average number of episodes
• Episodes with 5 or 6 visits
• Non- Low-Utilization Payment Adjustment (LUPA) payments
• High therapy utilization episodes
• Outlier payments

For More Information:

•, including a sample HHA PEPPER

Submit questions to the Help Desk
The Medical Management Institute – MMI – Medical Coding News & MMI Updates

Medical coding one of the fastest growing sectors in health care: Coders getting certified!

Health information technicians are considered as one of the 10 fastest-growing allied health occupations according to the US Bureau of Labor Statistics (BLS), with Medical billers and coders being in high demand among the allied health occupations.

Further increase in terms of job outlook is expected in the sector of Medical Coding with demand for professionals expected to increase by 18% considering the increased shift from paper to data storage in patient documentation and increased shortage of qualified professionals with specialized skill-sets. 

According to the U.S. Department of Labor continued job growth for medical coders and billers is stimulated due to the increased medical need of geriatric population and the number of health practitioners. Moreover the Occupational Outlook Handbook states that earnings vary widely and pay levels are ascertained mainly as per experience and qualifications, hence various medical coders are opting for certifications in varied specializations to make the most of the growth in this sector. 

Medical Coders rational in getting certified: Opportunities through certification

A national study of workers in their mid-30’s illustrated that 43% of license and certificate holders earned more than associate’s degree graduates, moreover as many employers prefer to hire candidates with certification, earning a Medical Billing and coding certification gives the coder an added competitive edge in the job market. On gaining experience in this field pursuing medical billing and coding certification in a particular specialty—beyond just basic certification— can immensely help in capturing the growth in this industry. In general, average salary for a medical billing and coding professionals is anywhere between $ 38,000 and $ 50,000 per year, while the ones at the top of their pay scale can earn more than $ 74,000. 

A recent survey by American Hospital Association depicts that nearly 18% of billing and coding positions remain vacant due to a lack of qualified candidates, with most physician practices in preference of hiring well qualified medical billers and coders – certified in their field, to as far as possible avoid legal ramifications of incorrect billing. Also various medical coders working independently from home at times need to get additional licenses and certification. 

Growing opportunities

In the scenario where Insurance companies and government are putting more emphasis in researching and controlling claims’ fraud, abusive practices, and medical necessity issues, has led to an increase in hiring by related healthcare entities. Being a challenging, attractive career with growing opportunities – where compensation is as per level of skills, individuals seeking a career in medical administration are well advised to opt for medical billing and coding with the entry-level pay being higher than that of comparative health care professionals in the field. equipped with experienced Billers and Coders well-versed with HIPAA, ICD-9-CM, ICD-10 –CM, CPT/HCPCS, DSM-IV, and ICPM, gives coders a platform to excel in their domain. Our coders are constantly training and updating themselves as per the industry requirements, striving to make the most and assist in the evolving healthcare industry effort in improving patient care. 

Medical coding and billing salary range is wide, with a low percentage of employees in this medical field expecting to see a salary of $ 31,000 per year while another percentage expecting to see a salary range as high as $ 48,000 per year. However the average salary for a medical coder and biller as stated earlier is expected to get a higher scope in upcoming years, nevertheless eventually only the medical biller and coder can determine their earnings depending on variables they adopt. providing updated knowledge, placement opportunities and analyzing current salary trends has been serving physicians for more than a decade and offers medical billers and coders an avenue to get connected with these doctors and can register with us for future job prospects. (Link to register for jobs) 

Medical Billers and coders (MBC) is one of the leading  Medical Billing Companies in USA & help doctors to shortlist Medical Billing Companies,  Medical Billing Services according to their preferences of specialty, city, software and services performed.

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