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Thought Leadership

When it comes to thought leadership and staying informed, we’ve got you covered. See below for recent articles, webinars, and downloadable resources available.

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2023 E/M Coding Changes You Need to Know from the Physician Fee Schedule Final Ruling

New rules for reporting evaluation and management (E/M) services in most places of service took effect January 1, 2023. The coding and documentation revisions, adopted by the American Medical Association’s CPT Editorial Panel and approved by the Centers for Medicare and Medicaid Services (CMS), substantially simplify code selection and documentation. Effective January 1st, E/M services […]

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Consolidated Appropriations Act of 2023 Changes Impacting Rural Health Clinics

The Consolidated Appropriations Act of 2023, also known as the “Omnibus” package, was signed into law by President Biden on December 29, 2022. Rural Health Clinics (RHCs) need to be aware of some of the changes that will impact them including new grant opportunities and behavioral health provisions. Opportunities for Rural Health Clinics from the […]

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Medicare Bad Debt Listing Template Finalized by CMS

This article has been updated on January 5, 2023. Back in August 2022, CMS was proposing changes to the Medicare Bad Debt listing template that is filed with your organization’s cost report. The new template (Exhibit 2A) has recently been finalized by Medicare and is now required for cost reporting periods beginning on or after […]

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Neurosurgery Operations Assessment: Ten Opportunities for Improvement

In response to the COVID-19 pandemic, neurosurgery practices across the United States are looking for creative ways to remain independent in private practice while ensuring they meet the needs of the neurosurgical care demand within their communities. Physician owners, partners, and private practice executives often wonder whether a diagnostic “biopsy” of their practice can be […]

Learn More

Physician Fee Schedule: 2023 CMS Final Ruling

The Centers for Medicare & Medicaid Services (CMS) operates within a budget neutral approach. This occurs at the same time the healthcare community continues to try and find balance between reducing administrative burdens, accurately recognizing and recording services provided, and upholding the highest quality care possible. Over the last three years, there have been significant […]

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Occupational Mix Survey: What You Need to Know

Every three years, the Centers for Medicare and Medicaid Services (CMS) requires any Hospital that is subject to the Inpatient Prospective Payment System (IPPS) to complete an Occupational Mix Survey (OMS). This data is then used to calculate an Occupational Mix Adjustment Factor (OMAF). The occupational mix adjustment impacts a hospital’s average hourly wage and […]

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Worksheet S-10 & Medicare DSH Update for Hospitals

FFY2020 Worksheet S-10 audits are in the final stages for most hospitals in the nation and we continue to see significant audit findings and extrapolation factors taking place throughout the industry. Please be sure to review all proposed S-10 audit adjustments closely to ensure your uncompensated care is maximized. Worksheet S-10: Two-Year Average of S-10 […]

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Infusions: Will your documentation pass a Targeted Probe and Educate Review?

For years, Blue & Co. has received questions from hospitals regarding coding and billing for infusions, as well as documentation requirements. Infusion coding can be some of the most difficult coding for hospitals. It takes a certain understanding of 1) the required hierarchy, 2) what happens if a stop time is not recorded, 3) how […]

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Five Steps to Build Successful Growth Strategies

In a post-pandemic environment, providers are more likely to refer patients for procedures, diagnostic testing, and physician visits to non-hospital environments. This presents an opportunity for healthcare leaders to re-exam their growth strategies and develop structure to define the market opportunity, redefine access as defined by providers and customers, and leverage data to prevent leakage […]

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Creating a Financial Denial Prevention and Management Plan for Outpatient Therapy

Every hospital department deals with financial denials. Understanding the volumes of those denials for your outpatient therapy department can improve the net revenue of the department. A financial denial is when an insurance company or carrier refuses to pay for the healthcare services the individual receives. Within an outpatient therapy department, the level of denials […]

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Five-Star Quality Rating System: Changes Your Nursing Facility Needs to Know

On July 7, 2022 the Center for Medicare and Medicaid Services (CMS) released the updated Nursing Home Five-Star Quality Rating Technical Users’ Guide with the methodology for the changes to the Staffing Rating and the Overall Quality Rating. Here is what your facility needs to know. Changes to the Staffing Rating CMS is basing the […]

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Period 3 Reporting Now Open: PRF Update

Reporting on Provider Relief Funds for Period 3 opened on July 1, 2022 and runs through September 30, 2022. Period 3 reporting is for any PRF payments you may have received between January 1, 2021 to June 30, 2021. Compared to Period 1 and Period 2, there were very limited payments made by HRSA in […]

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Facility Emergency Department Leveling | Stethoscope laying on top of financial reports | Blue & Co., LLC

Is Your Current Facility Emergency Department Leveling Process Working?

Blue & Co. has performed many Emergency Department Leveling Reviews for hospitals. The two most utilized leveling criteria are “points-based” or “intervention-based.” In either case, each hospital must determine which facility resources (or attributes) to include within its criteria, and how these resources crosswalk into ED visit levels (99281-99285). This can create significant reimbursement differences […]

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Transparency and Advocacy in Patient Responsibility

How Transparency and Patient Advocacy Can Reduce Your Hospital’s Bad Debt

In 2019 patient medical debt in the U.S. totaled at least $195 billion, according to an analysis by the Kaiser Family Foundation, a nonprofit organization focusing on national health issues. This is a massive figure and should be looked at as an opportunity for healthcare organizations. A survey conducted by Kaufman Hall in August 2020 […]

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Referral Turn-Around Times in Outpatient Therapy

How Referral Turnaround Times in Outpatient Therapy Impact Your Organization

In a previous blog post, we talked about how poor insurance verification and authorization processes can cause patients to either not come to therapy or to go to a competitor who can facilitate those processes faster. We know that notwithstanding patient choice, outpatient therapy providers should be able to offer an evaluation appointment within 3 […]

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Webinars

2023 E/M Coding Changes You Need to Know from the Physician Fee Schedule Final Ruling

New rules for reporting evaluation and management (E/M) services in most places of service took effect January 1, 2023. The coding and documentation revisions, adopted by the American Medical Association’s CPT Editorial Panel and approved by the Centers for Medicare and Medicaid Services (CMS), substantially simplify code selection and documentation. Effective January 1st, E/M services […]

Learn More

Consolidated Appropriations Act of 2023 Changes Impacting Rural Health Clinics

The Consolidated Appropriations Act of 2023, also known as the “Omnibus” package, was signed into law by President Biden on December 29, 2022. Rural Health Clinics (RHCs) need to be aware of some of the changes that will impact them including new grant opportunities and behavioral health provisions. Opportunities for Rural Health Clinics from the […]

Learn More

Medicare Bad Debt Listing Template Finalized by CMS

This article has been updated on January 5, 2023. Back in August 2022, CMS was proposing changes to the Medicare Bad Debt listing template that is filed with your organization’s cost report. The new template (Exhibit 2A) has recently been finalized by Medicare and is now required for cost reporting periods beginning on or after […]

Learn More

Neurosurgery Operations Assessment: Ten Opportunities for Improvement

In response to the COVID-19 pandemic, neurosurgery practices across the United States are looking for creative ways to remain independent in private practice while ensuring they meet the needs of the neurosurgical care demand within their communities. Physician owners, partners, and private practice executives often wonder whether a diagnostic “biopsy” of their practice can be […]

Learn More

Physician Fee Schedule: 2023 CMS Final Ruling

The Centers for Medicare & Medicaid Services (CMS) operates within a budget neutral approach. This occurs at the same time the healthcare community continues to try and find balance between reducing administrative burdens, accurately recognizing and recording services provided, and upholding the highest quality care possible. Over the last three years, there have been significant […]

Learn More

Occupational Mix Survey: What You Need to Know

Every three years, the Centers for Medicare and Medicaid Services (CMS) requires any Hospital that is subject to the Inpatient Prospective Payment System (IPPS) to complete an Occupational Mix Survey (OMS). This data is then used to calculate an Occupational Mix Adjustment Factor (OMAF). The occupational mix adjustment impacts a hospital’s average hourly wage and […]

Learn More