Pharmacy Benefit Manager Drug Pricing and MAC Appeals - PBM MAC Appeals Pharmacy Benefit Managers drug pricing uses several metrics and Standards. Pharmacy Benefit Managers (PBMs) may use Maximum Allowable…
Integrated Medical Bill Review and Subrogation Integrated medical bill review combines silos into one solution. This article provides a summary of various strategies to determine the value of medical bills. Plaintiffs in…
Coronavirus Federal Regulation as of May 5, 2020 The Coronavirus Federal Regulation list as of May 5, 2020, is below. COVID-19 has spawned a massive amount of regulations. Strengthening Transparency…
Below is a list of coronavirus Federal legislation Coronavirus Federal Legislation continues as the Federal Government prepares to go $3 trillion into debt to fund emergency stimulus measures. As of…
U.S. Led in Contributions but Failed to Receive Commensurate Benefits In the two-year period ending at the close of 2019, the U.S. contributed $893 million to the World Health Organization,…
Practice Fusion Perverted the Intent of Key Patient Safety Measures in Clinical Decision Support in its Electronic Health Record Software According to publicly available sources on the U.S. Department of…
Effective January 1, 2020, with an implementation date of January 6, 2020, the Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing…
The Medicare Beneficiary Identifier (MBI) is now required for all Medicare transactions. In other words, for medical billing use of the MBI is essential. The Centers for Medicare & Medicaid…
Home Health Patient Driven Groupings The Centers for Medicare and Medicaid (CMS) announced a new Patient-Driven Groupings Model for Home Health that replaces the Prospective Payment System effective January 1,…
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Forbes published an article on December 11, 2019, after interviewing the Administrator of the Centers for Medicare and Medicaid Services (CMS), Seema Verma. Ms. Verma itemized three focus areas: the lack…
Medicare LCDs Medicare Local Coverage Determinations (LCDs) are inconsistent and cause uneven access to care for Medicare beneficiaries based on arbitrarily geographic boundaries and jurisdictions, rather than on medical necessity.…