Month: June 2021

Prolonged Services in CPT versus Medicare

Prolonged Services in CPT versus Medicare

The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from “typical” […]
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New Provider Relief Fund Rules Give More Time to Use, Report Money

New Provider Relief Fund Rules Give More Time to Use, Report Money

HHS recently updated Provider Relief Fund reporting requirements, extending the period of availability of funds and reporting periods. The update to the Post-Payment Notice of Reporting Requirements states that clinicians now have a period of availability of funds based on the date they received the payment, rather than the original deadline of June 30, 2021. […]
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CMS Updates Medicare Part B Drug Prices

CMS Updates Medicare Part B Drug Prices

Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive update to the April Average Sales Price (ASP) pricing file for three Medicare Part B drugs. Also now available are the July ASP and Not Otherwise Classified (NOC) pricing files and the ASP NDC HCPCS […]
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Emergency physicians call United healthcare’s ED denial Policy ‘Dangerous’

Emergency physicians call United healthcare’s ED denial Policy ‘Dangerous’

The American College of Emergency Physicians said that it “firmly believes that the new policy is in direct violation of the federal Prudent Layperson Standard.” Calling it a “dangerous decision” and a “scare tactic,” the American College of Emergency Physicians (ACEP) is condemning UnitedHealthcare’s recent announcement to retroactively deny emergency care claims. “ACEP firmly believes […]
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CMS Increases Medicare Payments for At-Home COVID-19 Vaccinations

CMS Increases Medicare Payments for At-Home COVID-19 Vaccinations

  CMS will increase Medicare payments by $35 per dose to administer at-home COVID-19 vaccines in an effort to increase the vaccination rate among beneficiaries. Medicare payments will increase by $35 per dose for providers who administer at-home COVID-19 vaccinations for Medicare beneficiaries, CMS announced today. In alignment with President Biden’s goal of ensuring vaccine […]
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CMS Releases PCS Codes Final Rule

Medical/Legal Impact of 2021 E&M Changes

Without detailed documentation, providers may face an uphill battle in defending themselves from quality audits and even malpractice issues. Up until 2021, at least for the prior two decades, coders and clinicians relied upon the established Evaluation and Management (E&M) guidelines to determine which E&M code was appropriate for each specific encounter. The 1995 guidelines […]
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