Category: Blog

Hospital Claim Denials Up for Most, Driven by Prior Authorizations

Hospital Claim Denials Up for Most, Driven by Prior Authorizations

  Hospitals and health systems are facing a growing volume of claim denials, with private plan prior authorization issues driving the recent increase, according to a new report from the American Hospital Association (AHA). For the report, AHA surveyed more than 200 hospitals and health systems in 2019 to understand the impacts utilization management practices employed by […]
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Managing Telemedicine Risks During the COVID-19 Pandemic

Managing Telemedicine Risks During the COVID-19 Pandemic

As more US patients are diagnosed with COVID-19, a number of industry associations have recognized telemedicine—the practice of using technology to deliver healthcare remotely—as a viable means to give patients access to care and minimize exposure to the disease. Adoption of virtual care has increased as the pandemic has significantly imperiled the country and the […]
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Final Rule Updates MIPS for 2021 and Beyond

Final Rule Updates MIPS for 2021 and Beyond

  CMS continues to phase in the Quality Payment Program while MACRA mandates loom. The long-awaited Physician Fee Schedule (PFS) final rule, now pending publication in the Federal Register, finalizes proposed updates to the Quality Payment Program (QPP) and its two tracks — the Merit-Based Incentive Payment System (MIPS) and Advanced Alternate Payment Models (APMs) — for performance […]
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Master 2021 CPT Changes With This Expert Overview

Master 2021 CPT Changes With This Expert Overview

CPT® 2021 includes 206 new codes, 69 revised codes, and 54 deleted codes. All sections of CPT® received changes in codes and guidelines, except Anesthesia. The most significant changes are to codes for office/other outpatient evaluation and management (E/M), prolonged services, breast repair and reconstruction, cardiovascular shunting procedures, and COVID-19 testing. Here is an overview […]
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CPT_AMA Announces a New PPE code – But is it Payable

CPT Code 99072: Reimbursement Challenges and Guidance

The American Medical Association (AMA) introduced a new CPT® code, aimed at covering additional provisions to ensure patient and provider safety during a public health emergency (PHE). CPT 99072: Additional supplies, materials, and clinical staff time beyond what is typically included in an office visit or non-facility service(s), when performed during a PHE due to […]
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6 Big Changes Coming for Office-Visit Coding

6 Big Changes Coming for Office-Visit Coding

Physicians will soon start having an easier time — and perhaps get paid more money — when they code for evaluation and management (E/M) services, thanks to the American Medical Association (AMA). The first major changes to the definitions for E/M services will be in effect as of January 1, 2021, with all payers expected […]
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CMS Finalizes 2021 Physician Fee Schedule, Including E/M Changes

After some delay due to the COVID-19 pandemic, CMS has released the final rule for the 2021 Medicare Physician Fee Schedule. The final rule unveiled by CMS yesterday evening will dictate how much Medicare physicians get paid for delivering care starting January 1, 2021. In the rule, CMS finalized a conversion factor of $32.41, which is a […]
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2021 Medicare Pay Schedule Eases Physicians’ Documentation Burdens

2021 Medicare Pay Schedule Eases Physicians’ Documentation Burdens

The final 2021 Medicare physician payment schedule includes a simpler, more flexible process for coding and documenting evaluation and management (E/M) office-visit services. But those positive changes, set to take effect in January, are accompanied by significant pay cuts for many physicians in specialties that provide relatively few office visits—cuts that come as the pandemic […]
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Two New Codes for COVID-19 Antibody Therapy

Two New Codes for COVID-19 Antibody Therapy

A new investigational monoclonal antibody therapy for Medicare patients with mild to moderate COVID-19 warrants new codes. The Centers for Medicare & Medicaid Services (CMS) announced Dec. 3 that it is implementing two new HCPCS Level II codes for Regeneron’s antibody casirivimab and imdevimab (REGN-COV2), effective for dates of service on or after Nov. 21. How To […]
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