Category: Blog

CMS Issues Long-Awaited, Controversial Final Rule on Price Transparency

CMS Issues Long-Awaited, Controversial Final Rule on Price Transparency

  A long-awaited and controversial final rule on healthcare price transparency was released Thursday by the federal government. The rule, mandated under a June 2019 executive order by President Donald Trump, requires private group health plans and individual health insurance market plans to disclose pricing and cost-sharing information in a consumer-friendly format. The mandate, which takes effect on January […]
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CMS Sets Medicare Reimbursement Rate for COVID-19 Vaccine

CMS Sets Medicare Reimbursement Rate for COVID-19 Vaccine

A new interim final rule with comment period ensures Medicare reimbursement for the administration of a COVID-19 vaccine and provider use of innovative treatments for the novel coronavirus. The rule released last night states that Medicare will pay providers $28.39 for the administration of a single-dose COVID-19 vaccine. In the event an approved COVID-19 vaccine requires multiple […]
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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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ICD-10 Coding Guideline Changes

ICD-10 Coding Guideline Changes

For 2021, there are 490 new, 47 revised and 58 deleted ICD-10-CM codes. We will cover the ICD-10-CM guidelines in this article and the ICD-10-CM code changes next month. There are several important changes to the guidelines, including those relating to COVID-19 coding. The updates for these were a little late this year due to […]
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CMS Provides Medicare Reimbursement for More Telehealth During PHE

CMS Provides Medicare Reimbursement for More Telehealth During PHE

CMS recently added 11 new services to the Medicare telehealth services list, qualifying the services for Medicare reimbursement through the COVID-19 public health emergency (PHE). The new telehealth services cover some cardiac and pulmonary rehabilitation services, as well as certain neurostimulator analysis and programming services. The additions to the Medicare telehealth list were made in […]
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6 Must-Know Coding Updates In 2020

  Becker’s ASC Review compiled a timeline of significant medical coding updates that have been proposed or implemented so far this year: January CMS began paying for certain angioplasty and stenting procedures in ASCs on Jan. 1, under its 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule. Here are the Current Procedural Terminology […]
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7 Questions About the Future of EHRs

7 Questions About the Future of EHRs

Usability and interoperability are top physician complaints, but will 2021 bring any relief? Physicians often see the EHR as the bane of their professional existence, complaining about awful user interfaces and a lack of interoperability with other systems that forces them to access multiple platforms to get the information they need on one patient. But […]
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E/M Changes Take Effect January 2021

  Good news for physicians tired of counting bullet points to assign an evaluation and management (E/M) level for an outpatient office visit: Per new AMA guidelines, it’s going to be a whole lot simpler. As of January 1, 2021, physicians will select an E/M code based on total time spent on the date of […]
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The Need for Facility Coding Guidelines

The Need for Facility Coding Guidelines

Facility-specific coding guidelines are key to code hospital visits and encounters consistently. Another role that facility-specific guidelines play is to capture all possible reimbursement that is due to an organization. Every Oct. 1, the MS-DRGs and ICD-10-CM/PCS are updated. In addition to the MS-DRGs, the New Technology Add-On Payments (NTAPs) are updated as well. It […]
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