The Centers for Medicare and Medicaid Services (CMS) has released a summary of each HCPCS Level II code application decision. The document is twenty-eight pages long and the link can be found in the Resources section. There are 23 items included in the HCPCS Level II Code Q2 2024 Drug and Biological decisions. Twenty new […]
H5N8 Avian Influenza Vaccine: The American Medical Association (AMA) has updated the Current Procedural Terminology (CPT) code set to include new codes for vaccines protecting against the H5N8 strain of avian influenza. This update follows a recent global outbreak of avian influenza, particularly the H5N1 strain, which has affected wild birds, poultry, dairy cows, and […]
CMS is proposing new Billing Codes for MRI in the draft 2025 Medicare Physician Fee Schedule to account for the extra work involved in safely performing MRIs on patients with implants or other factors that could pose risks. These additional tasks might involve reviewing a patient’s medical history, researching implant specifics, carefully considering risks and […]
OPD (Chronic Obstructive Pulmonary Disease) is an umbrella term for lung diseases that make breathing difficult. This difficulty arises from blockage or narrowing of the airways. The two most common types are emphysema and chronic bronchitis, which often occur together. Smoking is the leading cause of COPD. While there’s no cure, measures can be taken […]
Value-Based Payment: Putting Patient Health First: When recommending a medical procedure, should doctors prioritize insurance reimbursements or patient health? The answer hinges on the payment model. In a fee-for-service system, providers are compensated for each individual service, potentially incentivizing excessive care. This model can lead to increased costs and harm patients through unnecessary treatments or medications. […]
A proposal to track prior authorization using CPT codes was pulled back for revision after a surprising finding. An urologist, advocated for the plan to compensate physicians for time spent on prior authorization requirements. He also hoped it would streamline the process and improve patient care. However, the American Medical Association (AMA) informed urologist that […]
Physician RCM: This guide dives into key areas physician private practices can target to strengthen their revenue cycle management (RCM), as outlined by the American Medical Association (AMA) in recent News. By optimizing these eight steps, practices can ensure timely and accurate reimbursement for services provided. 1. Patient Registration: Accuracy First The foundation of a […]
Accurate coding is essential for retina practices performing intravitreal injections, especially when handling retina injection coding. While medication and modifier updates occur frequently, understanding these basics ensures proper reimbursement: CPT® Code Consistency: CPT® code 67028 remains constant for administering the medication. HCPCS Level II Code Tracking: Codes for injected drugs (HCPCS Level II) vary and […]
ESRD PPS 2025 Update: In the July 5 Federal Register, the Centers for Medicare & Medicaid Services (CMS) will publish a proposed rule for the calendar year (CY) 2025 End-Stage Renal Disease Prospective Payment System (ESRD PPS). A number of changes to Medicare policy and payment rates for ESRD facilities are included in the rule. Changes […]
Following a major cyberattack on Change Healthcare, a subsidiary of UnitedHealth Group (UHG), confusion arose regarding who would handle the Change Healthcare cyberattack HIPAA breach notification for potentially millions of affected individuals. HIPAA regulations govern such notifications, but the situation presented unique challenges. In May 2024, the Department of Health and Human Services (HHS) issued […]