Category: Blog

CMS Fights Growing Number of Appeals

CMS Fights Growing Number of Appeals

Providers are encouraged to file protective appeals. “In section XI of the preamble of the proposed rule, we discussed the growing number of Provider Reimbursement Review Board (PRRB) appeals made by providers and the action initiatives that are being implemented with the goal to decrease the number of appeals submitted; decrease the number of appeals […]
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Understanding Why 99201 Will be Deleted

Understanding Why 99201 Will be Deleted

An overview of the proposed Medicare Physician Fee Schedule: The proposed Medicare Physician Fee Schedule (MPFS) rule for 2020 was officially released on Aug. 14, 2019, encompassing various elements. Among these are proposals such as adjusting the PFS conversion factor to $36.09, introducing new HCPCS codes for bundled episode-of-care treatment for opioid use disorders, revising […]
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Evaluation and Management Codes

Evaluation and Management Codes…Why Bother?

Denials and how to not get discouraged with evaluation and management codes, and how to appeal There Is Little More Frustrating To Chiropractors And Billers Than Evaluation And Management Codes: While the service is required both clinically and documentation-wise, it is being bundled more and more often by third-party payers. If both the chiropractic manipulative […]
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Temporary CPT Codes

Hospitals Call on CMS to End Temporary CPT Codes for Non-Physician Services

The healthcare industry is abuzz as hospitals and health systems intensify their calls for the Centers for Medicare & Medicaid Services (CMS) to eliminate the use of “temporary CPT codes” for non-physician services. Providers argue that these codes create unnecessary administrative burdens and payment delays, complicating billing processes at a time when operational efficiency is […]
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More Changes Ahead for Evaluation and Management Services

More Changes Ahead for Evaluation and Management Services

Changes to payment, coding, and documentation policies for evaluation and management (E/M) services finalized in the 2019 Physician Fee Schedule (PFS) final rule are necessary to align with the American Medical Association’s (AMA) revisions to the 2021 CPT code set for office/outpatient E/M visits, according to the Centers for Medicare & Medicaid Services (CMS). The proposed policy changes for E/M visits are […]
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