Month: April 2022

CMS, HHS Finalize 2023 Notice of Benefits, Payment Parameters

CMS, HHS Finalize 2023 Notice of Benefits, Payment Parameters

  CMS and the Department of Health and Human Services (HHS) released the 2023 Notice of Benefits and Payment Parameters Final Rule, which includes standardized plan options, changes to network adequacy reviews, refinements to the Affordable Care Act’s essential health benefits nondiscrimination policy, and other changes. “The recent Open Enrollment Period demonstrated the demand for […]
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AMA announces CPT update for COVID-19 booster candidates

AMA announces CPT update for COVID-19 booster candidates

The American Medical Association (AMA) today announced an editorial update to Current Procedural Terminology (CPT®), the nation’s leading medical terminology code set for describing health care procedures and services, that includes newly assigned provisional CPT codes for COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline. The Pfizer booster candidate is proposed for use in children ages […]
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Barostim Heart Failure Treatment: Coding Training

Barostim Heart Failure Treatment: Coding Training

The Centers for Medicare & Medicaid Services (CMS) has begun covering a portion of the device cost for Barostim Neo, a neuromodulation device for treating chronic heart failure. In late 2020, the Centers for Medicare & Medicaid Services (CMS) announced that it would begin covering a substantial portion of the cost of implantable heart failure […]
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Revenue Cycle Leaders Experience Price Transparency Rule Burden

Revenue Cycle Leaders Experience Price Transparency Rule Burden

Revenue cycle leaders noted that the confusing regulations included in the CMS price transparency rule make it difficult for their organizations to achieve compliance. The majority of revenue cycle leaders were dissatisfied with aspects of the CMS hospital price transparency rule and expressed doubt about the regulation’s efficacy, according to a KLAS report RevCycleIntelligence received […]
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Cms proposes more than 1k new diagnosis codes

Cms proposes more than 1k new diagnosis codes

Brain illness and injury, with a focus on dementia-related diagnoses, occupy a high volume of the 1,495 proposed changes to the ICD-10-CM diagnosis code set by CMS in the fiscal year (FY) 2023 inpatient prospective payment system (IPPS) proposed rule. At the same time, CMS also introduced a minimal amount of new ICD-10-PCS procedure codes, […]
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What’s driving the transition to value-based care?

What’s driving the transition to value-based care?

The COVID-19 pandemic has taught us it’s possible for the health care system to transform care delivery—and quickly. We saw vaccines come to market in record time, heightened cross-industry collaboration to track vaccine statuses, and virtual care use surge. Similarly, the pandemic demonstrated that value-based care delivery models, where payment is based on outcomes versus […]
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HHS Distributes $1.75B in Phase 4 COVID-19 Provider Relief Funds

HHS Distributes $1.75B in Phase 4 COVID-19 Provider Relief Funds

  Around 3,600 healthcare providers that have experienced pandemic-related revenue losses and expenses will receive payments through this round of Phase 4 COVID-19 Provider Relief Funds. Through the Health Resources and Services Administration (HRSA), HHS has released the fifth round of Phase 4 COVID-19 Provider Relief Funds, which includes $1.75 billion for healthcare providers that […]
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Confirm Dosage for New COVID-19 Booster

Confirm Dosage for New COVID-19 Booster

NDCs will help you determine when to use 0094A and 91309. If you’ve been waiting for news on Moderna’s booster dose-specific COVID-19 vaccine for adults, check this out: The Food and Drug Association (FDA) revised the emergency use authorization (EUA) to include this booster as of March 29, 2022. Assign 0094A, 91309 for Booster Dose […]
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