Journal of Urgent Care Medicine

Claim Submission Final Rule Puts Your Fax Machine On Notice

The Centers for Medicare & Medicaid Services (CMS) finalized a rule this month that is meant to drive healthcare transactions away from fax machines and postal mail. Too many providers are still using these old-school workflows with surprising frequency for submitting claims documentation today, and CMS believes the Adoption of Standards for Health Care Claims Attachments Transactions and Electronic Signatures Final Rule represents a major step toward fully electronic workflows, according to a press release. …

Hospitals Wave Red Flags as UnitedHealthcare ED Policy Takes Effect

UnitedHealthcare (UHC) just launched a new protocol for evaluating emergency room claims that it says will encourage accurate coding by providers and ultimately bring down healthcare costs. Some hospitals view it as just another way to deny claims, however—and one that could actually end up costing patients more money, at that. Under the policy that took effect on March 1, UHC reviews and maintains the right to adjust or deny claims for ED visits coded …

Are You Maximizing Claims on Radiology, Pathology, and E/M Services?

Date-of-services rules can be cumbersome on a good day—and can even turn an otherwise good day into a major headache for coders. A Medicare administrator contractor (MAC) put forth a provider outreach and education (POE) recommendation recently aimed at leveling out that “uphill battle” when it comes to complying with date-of-service requirements. An article in published online by DecisionHealth recommends clarifying the specific date-of-service rules your urgent care center follows when reporting common radiology, pathology, …

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