Every year, the Trends in Healthcare Payments Annual Report is distributed to start a conversation about the current state of the industry and shine a light on areas where change is needed. For healthcare providers, the report has consistently found that more of their revenue is dependent on out-of-pocket payments from consumers and less is covered […]
How to code Medicare Part B claims for reimbursement. These past few months have been a whirlwind for everyone, but it’s fair to say medical coders have been hit with a category 5 hurricane. New codes and revised guidelines have been whirring about, making our heads spin. And now we have another new CPT® code […]
For several years, we’ve seen Medicare and the American Medical Association’s Current Procedural Terminology (CPT) manual slowly approach the age of telehealth. Despite a lot of discussion and many headlines during each of the past few years, the codes and coverage embracing the modern age of medicine have lagged far behind the technology. This isn’t […]
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 […]
Over the past couple of months, the COVID-19 crisis has disrupted the traditional delivery of care. Some patients are avoiding clinical settings out of fear of catching the virus. But now that regions are starting to re-open, people are looking for guidance and comfort to re-engage. Provider organizations need to be proactive and drive revenue […]
The entire list of proposed changes to ICD-10-CM/PCS codes is available in tables 6A-6K and 6P.1a-6P.4a of the rule. CMS released the fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) proposed rule May 11, which includes just shy of 600 ICD-10-CM code changes. Proposed changes include 490 code additions, 47 revisions, and 58 invalidations, slated to […]
Without much warning, the novel Coronavirus, or COVID-19, has taken over our healthcare system. It has taxed our healthcare workers, our national stockpiles of PPE, and affected millions of Americans nationwide. In addition to healthcare workers on the front lines, the pandemic has also impacted the healthcare revenue cycle, causing major confusion, questions, and inconsistencies as […]
Become a coding superhero with X-ray vision. When is imaging separately reported, and how? The relative value units (RVUs) for some codes include the provider’s use of imaging to accurately visualize the specimen or problem the code is meant to address. The most notable changes with regards to radiology for 2020 can be found […]
CMS is now offering MIPS credit for all participating clinicians of the Quality Payment Program to help report and provide COVID-19 data. The Centers for Medicare & Medicaid Services (CMS) is asking all clinicians in the Quality Payment Program (QPP) to contribute to the scientific research and reporting efforts to help curb the spread […]
Reimbursement details have not yet been established. The American Medical Association (AMA) CPT® Editorial Panel has made adjustments to one code and introduced two new codes to enhance the specificity of serology laboratory testing. These codes, released on April 10, are immediately applicable. Reimbursement arrangements for the Centers for Medicare & Medicaid Services (CMS) are […]









