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Seth Flam, DO

Lead Blogger: Seth Flam, DO

Dr. Flam is one of the founders of HealthFusion and serves as the company's CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR.

CMS Clears Up Chronic Care Management Confusion Over Medicare Advantage and More, Part II

Chronic Care Management and Medicare Advantage
In our previous blog post, we discussed clarification provided by CMS on the Chronic Care Management coding program, which has generated many questions. You can read the first blog post now. Here is the second part of the summary of the Q&A session from the CMS MLN Connects call on February 18, 2015: Q: Regarding the requirement that we share the care plan information electronically with other providers; what happens if one of the providers cannot receive that information electronically? A: We talked to the Office of the National Coordinator for Health […] Continue Reading

CMS Clears Up Chronic Care Management Confusion Over Medicare Advantage and More, Part I

Chronic Care Management and Medicare Advantage
CMS clarified lingering questions about the new Chronic Care Management code under Medicare Advantage plans recently in a memo to Medicare Advantage organizations and on other topics in a February Q&A session at the end of an MLN Connects National Provider Call. In the memo regarding Medicare Advantage, Kathryn Coleman, director of the Medicare Drug & Health Plan Contract Administration Group, confirmed that the CCM was a covered Medicare Part B service “included in the basic benefit offered by every MA (Medicare Advantage) plan.” However, Coleman noted that Medicare Advantage organizations “have […] Continue Reading

ICD-10 Deadline Delay Unlikely; SGR Fix Delayed But Likely

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The ICD-10 deadline is set for October 1, 2015—but will it stick? The deadline has been pushed out twice before, of course, and industry experts are holding their collective breath waiting to see whether Congress will once again delay implementation of the new code set. The House overwhelmingly approved a fix for Medicare’s Sustainable Growth Rate (SGR) without any change to the ICD-10 deadline, which was a relief to those hoping to implement ICD-10 this year. But then the U.S. Senate adjourned for a two-week recess on March 27 without acting on […] Continue Reading

Will the New Chronic Care Management Code Be Covered Under Medicare Advantage?

Chronic Care Management and Medicare Advantage
As the new Chronic Care Management code program is rolled out, providers have raised multiple questions that have yet to be answered about reimbursement for the code. One of the questions that have arisen in our recent webinars on the new program was whether the Chronic Care Management code would be covered under other programs such as Medicare Advantage. Currently, as we understand it, chronic care management is only covered for fee-for-service Medicare patients. This question has apparently been raised in other venues as well. At a recent educational session, CMS representatives […] Continue Reading

Free Webinar—How to Get Paid for the New Chronic Care Management Code

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Thursday, January 22, 2015 – 1:00 PM Eastern time/10:00 AM Pacific time Under a new chronic care management program authorized by CMS and taking effect in 2015, you can bill for care that you are probably already providing to patients with two or more chronic conditions. But as with most CMS programs, there are very specific requirements you need to meet in order to bill for this code. That’s why you need to understand how to manage this program as soon as possible. In this complimentary webinar, you’ll review how to: Draft a […] Continue Reading

RACs Collected Nearly $4B in 2013; Will Your Medical Billing Software Help Protect You?

Can you medical billing software protect you from a RAC audit?
The Medicare Recovery Audit Contractor (RAC) program identified $3.75 billion in improper payments in 2013, according to CMS’ annual RAC report to Congress. That represents an increase over 2012, when the RAC program recovered approximately $2.4 billion. That, in turn, was an increase over 2011, when the RAC program recovered less than $1 billion. You can see the trend here—RACs are aggressively looking for monies to recover. The Recovery Audit Contractor (RAC) program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments paid to healthcare providers under fee-for-service (FFS) Medicare plans. For […] Continue Reading

Denial Management: Can You Afford to Throw Away $25 for Each Denial?

denial management - don't throw money away
A recent MGMA report showed that the average cost to rework a claim is $25. That means every claim that’s denied or rejected—every claim—is costing you an average of $25. Let’s do the math: If your staff must rework 100 claims every month, it’s costing you: $2,500 per month Why let that revenue flow out your door? By analyzing and fixing the problem, whether with one biller, practice-wide or with a particular payer, you can save your practice a substantial sum of money that goes right to the bottom line. In a […] Continue Reading

Free Webinar – Don’t Be Denied: Avoiding Billing and Coding Errors

Don't be Denied--Avoiding Billing and Coding Errors
Tuesday, September 16, 2014 – 1:00 PM Eastern / 10:00 AM Pacific   Stopping the denial on an individual claim is just the first step. Rather than simply fix and resubmit, smart practices research the source of their denials and use technology to understand the reason for the denials.  This prevents repeating the same billing and coding mistakes over and over.  Sophisticated practices go beyond simple claims scrubbing and use denial edits based on use of modifiers, bundling edits and medical necessity. This is only possible if a practice takes the time to […] Continue Reading

Why are Practices Replacing Their Medical Billing Software? Survey Reveals Buying Trends

medical billing software buying trends
A recent survey by leading practice management software review site Software Advice found that several trends around medical billing software acquisition have emerged. Some of the trends driving medical billing software buyers that were revealed by the survey include: Just as with electronic health record (EHR) software, the majority of practice management software (PMS) buyers are replacing existing medical software Concerns about ICD-10 preparedness are driving medical billing software replacements 40 percent of respondents prefer practice management software with an integrated EHR Practice management software buyers expressing a preference opt for web-based software over server-based, just […] Continue Reading

Could the ACA Choke Your Medical Billing This Quarter?

Medical billing challenges
Practices face new challenges in collecting patient responsibilities in 2014 under the Affordable Care Act, and the majority of providers may not be aware of the problem. 81% of physicians don’t feel they have enough information on the ACA to understand its impact on their practice and comply with its requirements, according to a survey by QuantiaMD, a social learning network for physicians. Unfortunately, this lack of information could be extremely costly for providers due to the grace period allowed for patients to pay for their insurance coverage. This grace period could […] Continue Reading