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March - April 2016 •
Volume 21, Issue 2

What's New in 2016? A Focus on Value
Message from the President
By Holly Louie, RN, CHBME
Education is undergoing a major overhaul. HBMA's new Educational Task Force, facilitated by Michelle Durner, is confirming final presentations for our new fall conference – HBMA 2016: The Healthcare Revenue Cycle Conference. In addition, they are revamping our webinar offerings. Click for more

HBMA Members Sound Off on Hot Topics
By Billing Editors
Topic: Which recent government healthcare policy or regulation has affected your business most and why? Click for more

2016 HBMA Compliance Conference
By Holly Louie, RN, CHBME
If there is one sentence that describes the 2016 Compliance Conference, held May 3-5 in Atlanta, it is "Pay attention, even when you think you already do." Did you know the HBMA Compliance Conference is the only conference dedicated to compliance in our industry? Click for more

2016: The Year of the Regulation
Physician Payment is Getting Trickier
By Bill Finerfrock
In Chinese culture, 2016 is the "Year of the Monkey." For those involved in healthcare, 2016 will be the year of the regulation! Click for more

Get the Most Out of Value-Based Reimbursement
Treat Your Negotiations Like Chess
By Steve Selbst and Susan E. Charkin
It's the biggest trend in healthcare this century: value-based reimbursement, which bases provider reimbursements on quality and value components instead of the standard fee-for-service model. Click for more

Medicare Advantage Plans and Risk Score Fraud
Allegations of Fraud Bring Increased Audits
By Julia Leo
Medicare Advantage Plans (MA Plans) are a "type of Medicare health plan offered by a private company that contracts with Medicare" to provide beneficiaries with all Part A and Part B benefits for which they are eligible. Beneficiaries must be enrolled in Medicare Part A and Part B in order to join an MA Plan. These plans can take several forms, including health maintenance organizations, preferred provider organizations, and private fee-for-service plans, as well as medical savings account plans and special needs plans. Click for more

Navigating the Insurance Claim Process
Approval Is in the Details
By Jeffrey L. Greyber, Esq.
I had a great discussion with a few billing company owners ­at HBMA's Fall Annual Conference regarding how important it is to approach the insurance claim process in detailed, organized fashion. These folks realized that the oft bumpy insurance claim process can be smoothed out if approached thoughtfully and thoroughly. Click for more

A Conversation with CAQH Deputy Director Gwen Lohse
HBMA Interview
By Billing Editors
For many of you, the CAQH Committee on Operating Rules for Information Exchange (CORE) is an important entity for revenue cycle management. CAQH recently awarded 200 CORE certifications to health plans, hospitals and health systems, clearinghouses, and vendors. Click for more

Make Your Electronic Claims More Efficient
Tips for Before, During, and After Claim Submission
By the American Medical Association
In order to improve the efficiency of physicians' healthcare claims submissions, HIPAA mandated use of a standardized electronic claim throughout the healthcare industry. Since then, the standardized electronic claim has been widely adopted throughout the industry, with over 92 percent of health plans and providers utilizing the transaction in 2013. Click for more

Percutaneous Urinary Procedures Reporting in 2016
Coding Corner
By Jackie Miller, RHIA, CCS-P, CPC
There were major changes to the CPT codes for percutaneous urinary procedures in 2016. Code assignment for these procedures has historically posed challenges regardless of whether the codes were assigned by a coder or by the physician. This column will review the new and revised codes for diagnostic antegrade imaging and drainage procedures. Click for more

Excel Charting Tips: Part Two
By Nate Moore, CPA, MBA, CMPE
This article continues the January/February 2016 issue's introduction to Excel 2013 chart tools. In part one we discussed the new interface for building charts, focusing on the Chart Elements tool (a plus-sign icon). This article covers the paintbrush icon that controls Chart Styles and the filter icon that controls Chart Filters. Click for more

How to Code Complications
By Valerie Fernandez, MBA, CPC, CPC-H, AHIMA ICD-10 Trainer
Complications are an unfortunate outcome for some patients who receive medical treatment. This article provides an overview of how to properly determine and code complications. Click for more

Virtual Credit Cards (Or: One More Kick in the Pants
From the Road
By Dave Jakielo
I'm sure by now some of your clients have received a surprise in the mail from a third-party payor, known as a virtual credit card payment. Although a physical plastic card is never issued, the card information is printed on paper and mailed to the provider with the explanation of payment. Click for more

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