Healthcare Data Management, Inc. believes in fostering a culture of compliance and seeks to maintain inscrutable compliance plans, records, and training. Our goal is to not only meet official government regulations, but to truly protect the patients that our clients entrust us to serve. A key piece of our compliance journey is through the HBMA Compliance Accreditation program. HDM has maintained Compliance Accreditation since enrolling with the program in 2020. ...

In December 2020, Congress signed the Consolidated Appropriations Act (CAA) into law. One section of the new law, referred to as the No Surprises Act, requires carriers to display deductible and maximum out-of-pocket limitations on member ID cards for coverage beginning January 1, 2022. The No Surprises Act is designed to prevent consumers from facing unexpected out-of-network expenses. While there are many provisions built into this law, one of them ...

Many healthcare providers (and sometimes even coders and medical billing companies) incorrectly believe that anytime an E&M (evaluation and management code, 99XXX series) is billed with another service, the modifier 25 needs to be appended to the E&M. The rationale behind Modifier 25 is that it communicates to the insurance carrier that the exam was significant and separate from the work involved in the other procedure performed on that day. ...

CMS (Centers for Medicaid & Medicare Services) is getting on board with stopping identity theft and fraud by issuing new Medicare cards. The Problem: For years, Medicare has used patient’s social security numbers as the basis of the member’s ID. The SSN is currently printed on every patient’s Medicare insurance card, which makes patients more vulnerable for having their SSN improperly exposed. The Solution: CMS will begin to issue and ...

We have the opportunity to work with many different clients and each practice has specific needs regarding medical record keeping. Some of our clients are entirely paperless and exclusively use an Electronic Health Records (EHR). Some of our clients are bucking the trend toward electronic records and maintain the tried-and-true record keeping developed over the lifetime of their practice. We work with clients of both backgrounds and can confidently say ...

MACRA & MIPS – Coming our way! We want to be sure our clients are kept in the loop on upcoming Medicare changes and payment models. The new acronyms to know are MACRA and MIPS…  MACRA (Medicare Access and CHIP Reauthorization Act ) is the umbrella piece of legislation passed in 2015 that is aimed at shifting healthcare reimbursement from strictly fee-for-service quantity to a value-based system to pay for ...

It’s been awfully quiet recently on our healthcarebiller blog – but not for lack of activity within our office! Our team is busily working to prepare for the upcoming changes in the industry, while supporting our current and new clients with the transition. What transition is that? Well – the one that you probably can’t stop hearing about: ICD-10! Since we are a multi-specialty billing company, we treat each of our practices ...

  A provision of the Affordable Care Act required Medicaid programs to reimburse primary care providers (PCPs) at a matching level to the Medicare rates in 2013 and 2014 for EM codes and vaccine admin codes. The federal government funded the increase at 100 percent. Based on the original legislation, federal funding for the increase is scheduled to end on December 31, 2014. HOWEVER, the state of Maryland has budgeted ...

  Below is a look at some of the key changes that the Centers for Medicare & Medicaid Services (CMS) issued in its final rule on October 31, 2014. These changes will become effective January 1, 2015. This summary is informed by CMS’ 10/31/2014 published “Fact Sheet: Policy and payment changes to the Medicare Physician Fee Schedule 2015.” Sustainable Growth Rate (SGR) The proposed 21.2 SGR cut that looms over physicians every year ...