Category: Medical Billing

Updates on COVID-19 Billing and CS Modifier Audits

Updates on COVID-19 Billing and CS Modifier Audits

The pandemic continues to impact Medicare reimbursement. COVID-19 continues to make news on the regulatory front with two new directives from the Centers for Medicare & Medicaid Services (CMS), centering on testing for the deadly coronavirus and formal coding edits for the Medicare Administrative Contractors (MACs) on payments with the CS modifier. There’s a new […]
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CMS Revises Billing Instructions for Inpatient Covid-19 Claims

CMS Revises Billing Instructions for Inpatient Covid-19 Claims

CMS provided clarification on submitting inpatient claims for patients diagnosed with novel coronavirus (COVID-19) without a positive viral test, in an update to MLN Matters SE20015 released September 11. Earlier this year, the CARES Act increased the MS-DRG weighting by 20% for a COVID-19 diagnosis. Although the CARES Act doesn’t specify that the diagnosis must be supported by a […]
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Take a Consumer-Oriented Approach to Your Billing Cycle

Take a Consumer-Oriented Approach to Your Billing Cycle

The Covid-19 pandemic is transforming how physicians practice medicine and bill for it. Physicians who take a consumer-oriented approach to their billing cycle may adapt the best, says John Behn III, MPA, president of Stroudwater Revenue Cycle Solutions and a principal of Stroudwater Associates, a national healthcare consulting firm based in Portland, Maine. “We’ve seen […]
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A View into Proposed Medicare PFS and Policy Changes for 2021

A View into Proposed Medicare PFS and Policy Changes for 2021

  The Centers for Medicare & Medicaid Services (CMS) in the past week has proposed Medicare payment rules for outpatient services and physicians for 2021 and finalized payment rules for inpatient rehabilitation facilities (IRFs) and psychiatric facilities. Looking specifically at the 2021 Physician Fee Schedule (PFS) proposed rule, scheduled to be published Aug. 17, it […]
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Billing and Documentation Guide for Patient Care During COVID-19 Pandemic

Billing and Documentation Guide for Patient Care During COVID-19 Pandemic

  The COVID-19 pandemic has brought about robust changes to the traditional practice of healthcare in the United States. In a time of social distancing and widespread quarantining, regulatory bodies, including the Centers for Medicare & Medicaid Services (CMS), have adapted to the current environment. The most critical goal was to allow healthcare providers to […]
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Providers Support Value in Health Care Act that Amends MACRA Payment Model

Providers Support Value in Health Care Act that Amends MACRA Payment Model

Among other provisions, the bill extends the 5% advanced APM bonus for an additional six years and modifies thresholds to achieve the bonus. Thirteen national provider groups support the newly-introduced House bill, the Value in Health Care Act of 2020, a bipartisan effort that proposes to make changes to the Medicare Access and CHIP Reauthorization Act (MACRA) […]
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How a Pandemic Impacts HIPAA Requirements

How a Pandemic Impacts HIPAA Requirements

As healthcare business professionals, we have been trained in the importance of following HIPAA privacy and security requirements. As coders, auditors, and health information services professionals we are bound by the HITECH Act of 2009, which outlines the responsibilities of “business associates” with respect to HIPAA requirements. As business associates, we are required to “appropriately […]
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Post COVID-19_ Medical Billing Finally Realizes the Value of Text-to-Pay

Post COVID-19: Medical Billing Finally Realizes the Value of Text-to-Pay

Contactless payments were on the rise even before COVID-19 hit. But now, health systems should see them as essential. Consumers are increasingly wary of touching a credit card terminal that others have used, a perfect conduit for spreading germs. For consumers, text payments serve as a convenient contactless way to pay, but there are other unique benefits […]
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Labs Welcome CMS Rate for Coronavirus Antibody Testing

Labs Welcome CMS Rate for Coronavirus Antibody Testing

CMS set the reimbursement rate for Medicare Administrative Contractors covering the main type of coronavirus antibody test at approximately $42, per an update Tuesday. That rate exceeds investment firm William Blair’s $25 estimate for the category of tests, boding well for future reimbursement policy for antigen testing, analysts noted. Last month, the agency doubled its reimbursement for high-throughput molecular […]
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4 Critical Attributes of A COVID-19 Billing And Coding Workbook

4 Critical Attributes of A COVID-19 Billing And Coding Workbook

  Our goal was to develop a single source of truth that is user-friendly, dynamic, and easily accessible,” said Jeannette Wood, vice president of revenue cycle management for Privia Health. A rapidly changing situation like the COVID-19 pandemic calls for a dynamic solution for tracking billing and coding changes for virtual services from different payers […]
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