Year: 2021

Introduction to the WHO’s ICD-11

Introduction to the WHO’s ICD-11

Cluster coding is a new feature for coding professionals. The World Health Organization (WHO) began developing the International Classification of Diseases, Eleventh Version (ICD-11), in 2007, and first released a preliminary version for evaluation and testing in 2016 – ironically, just one year after the U.S. finally adopted a clinical modification of the WHO’s ICD-10 […]
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The 2022 OPPS/ASC Final Rule Finalizes 2% Boost in Payment Rates

The 2022 OPPS/ASC Final Rule Finalizes 2% Boost in Payment Rates

CMS dramatically increases financial penalties for noncompliance with hospital price transparency rules. On Nov. 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, finalizing payment rates and policy changes affecting Medicare services furnished […]
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The Mississippi’s Medicaid Expansion Could Reduce State Medicaid Spending

The Mississippi’s Medicaid Expansion Could Reduce State Medicaid Spending

  Mississippi’s Medicaid program ranks poorly for its access to and quality of care, but Medicaid expansion could increase healthcare coverage along with lowering state Medicaid spending. Mississippi could achieve lower state Medicaid spending over the course of five years by expanding its Medicaid program with the American Rescue Plan boost to federal matching, a […]
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The Medical Coding News in November

The Medical Coding News in November

Take 5 to read up on recent coding and billing news. There are plenty of coding updates in November, including those made to certain Medicare policies. Payment thresholds for physical, occupational, and speech-language pathology are also posted for the 2022 calendar year, as are Medicare cost sharing amounts. And HCPCS Level II code set updates […]
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Learn More About 2022 HCPCS Level II Code Changes

Learn More About 2022 HCPCS Level II Code Changes

In first-quarter 2022, the HCPCS Level II code set will get a refresh with several new, revised, and deleted codes. According to the Centers for Medicare & Medicaid Services (CMS), there are: 155 new codes, 63 revised codes, and 48 deleted codes. Medical coders and billers: Familiarize yourself now with these code changes so you’re […]
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Telehealth use in Medicare increased 63-fold last year with behavioural health increasing the most

Telehealth use in Medicare increased 63-fold last year with behavioural health increasing the most

The number of beneficiaries in traditional Medicare using telehealth exploded 63-fold in 2020 from 840,000 in 2019 to nearly 52.7 million, a new study found. The study, released Friday (PDF) by the Department of Health and Human Services (HHS), comes as advocates are pressing to make key flexibilities the federal government enabled at the start […]
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Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage Plans and the Two-Midnight Rule

Medicare Advantage plans hold up their end of the contract with CMS, and provide, at a minimum, a fair reimbursement for services delivered. The physician advisor is a fast-growing specialty that has evolved into so much more than someone who performs endless chart reviews for observation status determinations, medical necessity reviews, peer-to-peer conversations with payors, […]
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