Category: Blog

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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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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Sequence ICD-10-CM Codes for Proper Payment

Key Concepts for Determining Primary Diagnosis Codes

Accurate diagnosis coding is crucial for medical billing, as it narrates the patient’s healthcare journey. Patients often present with multiple conditions, requiring coders to select and sequence the most specific codes. This sequencing, or code arrangement, is vital for correct billing. This discussion highlights five key terms from the ICD-10-CM Official Guidelines for Coding and […]
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ICD-10 Coding Tips for Influenza

ICD-10 Coding Tips for Influenza

There has been much discussion about COVID-19 this year, but as autumn approaches, thoughts turn towards influenza season. The Advisory Committee on Immunization Policies (ACIP) recently published guidelines for flu vaccination. Their advice is that routine annual vaccination is recommended for everyone 6 months of age and older. The United States vaccines will include updates […]
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New Medical Coding Rules for E M Visits

New Medical Coding Rules for E M Visits

Q: Do the new 2021 coding rules for office visits apply to all payers or just Medicare and Medicaid? Also, are these rules just for office visits, or can we use them for hospital visits, nursing home services, and home visits? A: The changes to the documentation requirements are for codes 99202-99215 only and are […]
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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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