Month: April 2021

CMS To Repeal Public Disclosure Of Payer-Provider Negotiated Rates

CMS To Repeal Public Disclosure Of Payer-Provider Negotiated Rates

The Centers for Medicare & Medicare Services on Tuesday unveiled a sweeping proposed rule that would nullify the mandated public disclosure of negotiated rates between payers and providers and increase by 2.8% Medicare’s inpatient prospective payment in fiscal year 2022. “The rule’s provisions seek to sustain hospital readiness to respond to future public health threats, […]
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Hospital Payments Increase 2.8% Under CMS Proposed Rule

Hospital Payments Increase 2.8% Under CMS Proposed Rule

The Centers for Medicare and Medicaid Services has updated the Medicare fee-for-service payment rates and policies for inpatient hospitals and long-term care hospitals for 2022. Before taking into account Medicare disproportionate share hospital payments and Medicare uncompensated care payments, the proposed increase in operating payment rates, increases in capital payments, increases in payments for new […]
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CPT Coding For Excisional Wound Debridement With VAC

CPT Coding For Excisional Wound Debridement With VAC

Q: What CPT codes and modifiers would be used to report excisional debridement for removal of a 2×4-cm ulcer on a patient’s right buttocks with vacuum-assisted closure (VAC)? A: The debridement would be reported using CPT code 11042 (debridement, subcutaneous tissue [includes epidermis and dermis, if performed]; first 20 sq cm or less). This procedure […]
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Health Policy Experts Offer 3 Fixes for Medicare’s ‘Dysfunctional’ Advanced-Imaging Payment System

Health Policy Experts Offer 3 Fixes for Medicare’s ‘Dysfunctional’ Advanced-Imaging Payment System

  Medicare Radiology Payment System approach to advanced imaging reimbursement has been “dysfunctional” for decades, but health policy experts have a few suggestions to fix it. Over the past 20 years, the federal payment program witnessed “substantial” increases in the performance of MRIs, CT scans and nuclear studies, mostly in doc offices. A shift later […]
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New Federal Transparency Requirements Impacting Health Providers and Plans

New Federal Transparency Requirements Impacting Health Providers and Plans

As promised, this is a follow-up to our first blog post on the new federal transparency requirements. In our prior post, we summarized the Hospital Price Transparency rule which went into effect on January 1, 2021, and here we discuss the transparency rules contained in the Consolidated Appropriations Act, 2021 (the “Act”), which apply to both health plans […]
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CPT Coding for E_M Visits with Wound Care

CPT Coding for E/M Visits with Wound Care

The service must be performed for a condition unrelated to the scheduled visit and must be a new condition that requires further evaluation. A version of this article was first published April 16, 2021, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders. Q: Is it appropriate to report an E/M code for visit […]
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