Tag: CMS Update

CMS Clarifies Organization Determinations: Key Updates for Medicare Advantage

CMS Clarifies Organization Determinations: Key Updates for Medicare Advantage

The Centers for Medicare & Medicaid Services (CMS) has introduced significant updates to clarify the definition and processes related to Medicare Advantage organization determinations, particularly in inpatient settings. The proposed rule reaffirms that decisions made during concurrent reviews, such as reclassifying an inpatient admission to outpatient or denying inpatient coverage, qualify as organization determinations under […]
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Charge Capture: A Critical Step in Revenue Cycle Management

Charge Capture: A Critical Step in Revenue Cycle Management

Charge Capture in Healthcare, a critical component of the revenue cycle management process, involves the accurate and timely documentation of all services rendered to patients. This includes procedures, tests, medications, and other healthcare services. While it may seem like a simple task, effective healthcare charge capture is essential to ensure optimal revenue cycle performance and […]
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HCPCS Level II Code Updates for July 2024

HCPCS Level II Code Updates for July 2024

The HCPCS Level II quarterly update for July 2024 is now available on the Centers for Medicare & Medicaid Services (CMS) website. The update includes: 134 added codes 9 discontinued codes 32 codes with long description changes 3 codes with payment changes New HCPCS Level II Codes Effective July 1, 2024, there is one new […]
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Updates to the E&M Codes and Guidelines in 2023

The E&M categories that will undergo revision in 2023 encompass: Inpatient and observation care services. Consultations – both outpatient and inpatient Emergency department services Nursing facility services Home and residence services Prolonged services Throughout the upcoming months, a dedicated focus will be placed on each E&M category, delving into the revisions and changes in guidelines. […]
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New Rules Issued for Modifiers 59, XE, XS, XP, and XU

New Rules Issued for Modifiers 59, XE, XS, XP, and XU

The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
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“Defensive” Undercoding Is Indefensible

“Defensive” Undercoding Is Indefensible

Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example: Undercoding Leaves Money On The Table, Driving Down Provider Reimbursement […]
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Preparing Providers For Value-Based Care

Preparing Providers For Value-Based Care, Consumerism In Healthcare

Technology can transform data into actionable insights for providers needing to meet the demands of value-based care and consumerism in healthcare. Transforming raw data into actionable information is crucial to the financial future of provider organizations, especially as pressure builds on providers to align their care delivery approach with value-based care and consumerism in healthcare. […]
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Federal Policy to End Surprise Billing

Federal Policy to End Surprise Billing: Building on Prior Approaches

Ending surprise medical bills has risen to a national priority with bipartisan political interest. In January, President Donald Trump directed Cabinet officials to find a solution, and multiple congressional bills were proposed in the last Congress with the same goal. Surprise medical bills consist of unanticipated charges from out-of-network clinicians—often when the facility or primary physician is […]
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Coding “Separate Procedures”

Coding “Separate Procedures:” What Coders Need to Know

“Separate procedure” may not mean what you think. Many procedural codes in the CPT® Book are designated as “separate procedures.” However, the common misinterpretation of this is that coders can report such codes as such in every case. Not true. First, you must consider: Were there other procedures performed during the same encounter? Did you consult […]
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