The powerful data analytic tools used for predicting patients at risk for high healthcare utilization, healthcare costs, and mortality are essential to a successful population health model of care.
Most covered entities still use mailings to communicate with patients and members, so it is worth revisiting Aetna's 2017 mailing breach and the surrounding litigation to understand where negligence occurred and to take away some valuable lessons learned.
CMS recently released updated guidance on billing intensity-modulated radiation therapy (IMRT) after an OIG audit found a 100% error rate in billing certain IMRT planning services.
It's been more than three years since CMS introduced a subset of modifiers it wants providers to report instead of modifier -59 (distinct procedural service), but they're still optional as barely any new guidance has been released.
As coders mark the third anniversary this October of the U.S. implementation of ICD-10, its newly minted successor is waiting in the wings, nearly ready for adoption.
