PAMA Reporting Regulations and Penalties

The PAMA law brought a wide variety of changes to Medicare, including the method by which Medicare will calculate the rates it will pay under the Clinical Lab Fee Schedule. Data collected from the period of Jan. 1, 2019-June 30, 2019, must now be reported to Medicare between January 1 and March 31, 2022 or potentially face fines of more than $10,000 per day.

computer generated image of Covid-19 virus in tube lined with 0s and 1s

Billing for COVID-19: Updated April 27

The COVID-19 pandemic continues to cause extreme financial hardship for hospitals, health systems and all providers. Falling operating margins and increasing denials make it even more important to stay abreast of regulatory changes regarding COVID-19.

Portrait of a sick patient coughing into tissue being helped via tele medicine by a male doctor wearing blue scrubs uniform using laptop

Take Steps to Stay Abreast of Evolving Telehealth Reimbursement

The use of telehealth has skyrocketed due to the COVID-19 pandemic. However, long-term uncertainty about Medicare reimbursement and wide disparities in the way commercial payers and Medicaid programs reimburse for telehealth mean providers must be extra-vigilant to limit denials and underpayments. Financially hard-hit providers must consider new revenue cycle management protocols to ensure the best chance for full reimbursement.

Hospitals Can Improve Collections by Targeting CARC 24 Denials

Hospitals can quickly and dramatically improve collections by reducing Claim Adjustment Reason Code (CARC) 24 denials, or claims rejected due to incorrect Medicare and Medicaid submissions.

Order-of-Insurance Denials Costs Money, Damages Patient Experience

When it comes to payment denials, some of the most common and potentially damaging involve Claim Adjustment Reason Code (CARC) 22, or order-of-insurance coverage problems. CARC 22 denials reduce cash flow, trigger unnecessary patient invoicing, and may undermine customer goodwill and harm the hospital’s overall patient experience and brand.

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