The Trump administration’s reinstatement of risk-adjustment payments is a genuine benefit for the insurance exchanges created under the Affordable Care Act (ACA), aka Obamacare, whether that was the president’s primary motivation or not. But there are still big challenges waiting in the wings for the exchanges, which currently cover 11.8 million Americans.

CMS’ 2019 Hospital Outpatient Prospective Payment System (OPPS) proposed rule introduces policies to reduce reimbursement for hospital outpatient clinic visits at off-campus, provider-based departments (PBD) and expand last year’s payment reductions for drugs purchased under the 340B discount pricing program by nonexcepted PBDs.

A huge embezzlement case in New York's Nassau County is a stark reminder that physician practices are likely targets for embezzlers, and many managers don’t make the simple adjustments that can prevent it from happening to them.

Sharpen your venipuncture coding to ensure you’re not losing out on easy money in the bank for one of the most common services that practices perform.

No one plans to make a mistake with patient diagnostic tests, but you can plan to avoid it by setting up a process for result review that removes room for error.

Chances are that you’re losing out on an opportunity to improve your patients’ health and secure additional reimbursement by ignoring the raft of preventive services covered under Medicare. Wrapping a questionnaire into your practice may help solve the problem.

Go the extra mile to run down your patients’ history of annual wellness visits (AWVs) and check off all your billing requirements, including the need for a diagnosis code, to avoid losing out on about $120 per encounter for subsequent AWV code G0439.