Category: Medical Billing

Updates Clarify Medicare Split/Shared Billing

Updates Clarify Medicare Split/Shared Billing

Know the facts for ensuring proper payment of these claims in 2022. New policy for split/shared evaluation and management (E/M) visits (including critical care services and prolonged services) was finalized in the calendar year (CY) 2022 Medicare Physician Fee Schedule (MPFS) final rule. Knowing the new guidelines for billing split/shared visits performed in the facility […]
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CMS Releases No Surprises Act State Enforcement Letters

CMS Releases No Surprises Act State Enforcement Letters

During a National Stakeholder Call on January 18, 2022, Ellen Montz—Deputy Administrator and Director of the Center for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare and Medicaid Services (CMS)—announced that CMS had begun publishing state-specific letters (the “Enforcement Letters”) detailing anticipated Federal and state responsibilities with respect to enforcement of the […]
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California lawmakers introduce bill to mandate vaccinations in workplaces

California lawmakers introduce bill to mandate vaccinations in workplaces

The bill comes in the wake of a U.S. Supreme Court decision blocking President Biden’s nationwide vaccine mandate for large employers. A group of California lawmakers, led by District 15 Assemblymember Buffy Wicks, have introduced a bill proposing that all businesses in the state mandate COVID-19 vaccinations for their employees. Assembly Bill 1993 would require […]
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Telehealth, EHR Use Increases False Claims Act Violations, Fraud

Telehealth, EHR Use Increases False Claims Act Violations, Fraud

As more providers leverage telehealth services and EHR systems, the federal government has seen increased False Claims Act violations and healthcare fraud. Healthcare digitization, including increased use of telehealth and EHR has led to a higher volume of healthcare fraud and False Claims Act (FCA) cases, according to lawyers from Hogan Lovells. The False Claims […]
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CMS Releases 2022 Physician Fee Schedule Final Rule

CMS Releases 2022 Physician Fee Schedule Final Rule

The Centers for Medicare & Medicaid Services (CMS) has finalized 2022 payments and policies under the Medicare Physician Fee Schedule (MPFS). The rule includes updates to payment rates for physicians and other healthcare professionals for calendar year (CY) 2022; expands the use of telehealth for mental health; clarifies policies related to split (shared) visits, critical […]
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No Surprises Act Notice Requirements: The Good and Bad News for Providers

No Surprises Act Notice Requirements: The Good and Bad News for Providers

Surprise billing occurs when patients receive care from out-of-network providers without their knowledge. On July 1, the Biden Administration passed an interim final rule: the first portion of the “Requirements Related to the Surprise Billing Act,” in an attempt to curb excessive costs patients are required to pay in relation to surprise billing. The rule […]
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Gain Insight Into Billing an E/M With OMT

Gain Insight Into Billing an E/M With OMT

Reducing denials starts with understanding osteopathic manipulation as well as coding and coverage guidelines for this therapy. Is it appropriate to bill an evaluation and management (E/M) service when osteopathic manipulative treatment (OMT) is performed at the same visit? We must address a few key principles to adequately answer this question. I learned quickly, having […]
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5 Things rev cycle leaders need to know about surprise billing interim final rule

5 Things rev cycle leaders need to know about surprise billing interim final rule

  Understanding the qualifying payment amount and the initial information on the independent dispute resolution process “should be a short-term priority for revenue cycle leaders and their teams,” says attorney Harvey Rochman. Earlier this month, the federal government released an interim final rule outlining certain provisions of the No Surprises Act (NSA), which is designed […]
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