What is HEDIS? Goals, Benefits, Improvements
HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET (HEDIS) INTRODUCTION Most health plans measure their quality and performance with the Healthcare Effectiveness Data and Information Set (HEDIS), one of the most widely used healthcare performance measurement tools. HEDIS provides consumers with measurement standards to compare health plan performance to help select their optimal healthcare coverage. In addition […]
SOAP Notes Template
Templates that enhance your SOAP Notes SOAP is something that you’re probably very familiar with if you’re in the medical field, but are you familiar with SOAP notes? This concept may be one that’s entirely foreign to you or one that you were taught in medical school. Whatever the case, SOAP note templates are a […]
What is a Health Maintenance Organization (HMO)
Navigating the world of health insurance can feel like you’re playing a game of Alphabet Soup. There are several healthcare plan options available. Let’s discuss Health Maintenance Organizations. What is a Health Maintenance Organization (HMO)? An HMO is a type of insurance plan. HMOs typically limit coverage to care from doctors, hospitals and other […]
Procedure Coding: When to Use the Modifier 26
Procedure Coding: When to Use the Modifier 26 This is part of the Modifier Series, the articles include: Modifers 59, 25, and 91 Modifier 59 Modifier 25 Modifier 26 The 26 modifier is a particularly unique coding tool in the billing and coding world. As we know, a modifier explains to payers the specific work […]
What is Chronic Care Management?
The Ins & Outs of Chronic Care Management By Meghan Franklin In 2015, Centers for Medicare and Medicaid Services (CMS) began paying separately under the Medicare physician fee schedule for chronic care management (CCM) provided to Medicare patients with two or more chronic conditions. According to CMS, approximately one in four adults have two or […]
What is a Prospective Payment System?
WHAT IS A PROSPECTIVE PAYMENT SYSTEM? A prospective payment system (PPS) is a constant healthcare payment system that relies on a medical diagnosis’s operating and capital costs. It sets up reimbursement for those who provide care to beneficiaries of Medicare and Medicaid. This indicates that healthcare givers have prior knowledge about the amount of cash […]
Procedure Coding: When to Use the 25 Modifier
PROCEDURE CODING: WHEN TO USE THE MODIFIER 25 Modifiers provide payers detailed information about what a doctor did while working with their patient. Modifiers play a crucial role in demonstrating the required medical decision-making (MDM) that a physician must show to bill and get paid for all services provided. This article is about modifier 25 […]
What is the Quadruple Aim?
By Meghan Franklin The Institute for Healthcare Improvement (IHI) developed the Triple Aim in 2007 to guide health policy. As it stands today, the Triple Aim’s goals are to: Improve the Health of Populations, Enhance the Patient Experience and Patient Outcomes, and Reduce the Per Capita Cost for Care for the Benefit of Communities The […]
Electronic Clinical Quality Measures (eCQMs) Updates for 2019
The Centers for Medicare & Medicaid Services (CMS) have posted the 2019 eCQMs updates including the 2019 reporting period for Eligible Hospitals and Critical Access Hospitals (CAH), and the 2019 performance period for Eligible Professionals and Eligible Clinicians. According to the eCQI Resource Center: eCQMs use detailed clinical data to assess the outcomes of treatment […]
How Prior Authorization Works in the Healthcare Industry
The term “prior authorization” on its own elicits feelings about security and privacy, as it should. When dealing with various technologies, authorization — authentication is a modern form of it — might require someone to get approval before accessing accounts or content. In the medical world, especially when dealing with insurance providers, the term or […]