AI coding at UMass Memorial tempers staffing shortage
UMass Memorial Medical Center’s radiology department has been able to sidestep a lack of bill coding professionals by adopting AI in the medical center’s coding for radiology. “It’s really hard to get certified coders these days,” said Barbara Scully, associate vice president, physician billing with UMass Memorial, which is located in Worcester, Massachusetts. “It’s one…
Bridging the gap: Integrating value-based care into revenue cycle management
The idea of value-based care (VBC) has existed for decades but only gained momentum since the 2017 implementation of the Merit-based Incentive Payment System (MIPS) and the Quality Payment Program (QPP). VBC incentivizes providers for quality outcomes, unlike fee-for-service models that reimburse providers for each service performed. The ultimate goal of VBC is to improve…
Navigate the new norms in telehealth billing and coding practices
While telehealth has been around for decades, its adoption soared during the COVID-19 pandemic. According to the American Medical Association, telehealth use grew 70% in 2020. While the use of telehealth since then has leveled off, it remains a valuable and popular care option. More than half of patients surveyed said they prefer telehealth for…
Navigating medical necessity denials: Strategies for successful resolution
Just as hospitals, health systems and physician practices are dealing with unprecedented financial and operational challenges, denied claims continue to rise — especially medical necessity denials. The impact on providers and patients is significant. Medical necessity is the term used to describe “healthcare services or supplies needed to diagnose or treat an illness, injury, condition,…