Tag: CMS Update


Significance of Medical Coding Strategies

Medical coding strategies contribute various benefits, counting cost reduction and control, systematic healthcare management, and increased scalability. Compliance with medical coding qualities also promises patients’ data privacy and security and alleviates the threats of audits. In the current healthcare landscape, keeping up financial solidity has become progressively hard due to the shift from fee-for-service to […]
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E-M Codes and Guidelines in 2023

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 […]
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23 New PLA Codes in Q3 of the CY 2022

A quarterly update to the Clinical Laboratory Fee Schedule (CLFS), issued by the Centers for Medicare & Medicaid Services (CMS) on Aug. 11, includes 23 new CPT® codes for proprietary laboratory analyses (PLA) tests. Medical coding and billing staff processing claims for lab testing should be aware of these code changes that are effective Oct. […]
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Updates on End-Stage Renal Disease Prospective Payment copy

Updates on End-Stage Renal Disease Prospective Payment

CMS issued a proposed rule to update payment rates and policies under the End-Stage Renal Disease Prospective Payment System for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2023. Here are four takeaways from the proposed rule: Under the proposed rule, Medicare expects to pay $8.2 billion to approximately 7,800 facilities […]
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Update on Medicare Reimbursement for ESRD facilitie image

Update on Medicare Reimbursement for ESRD facilities

The CY23 End-Stage Renal Disease (ESRD) Prospective Payment System Proposed Rule would increase Medicare reimbursement rates, among other policy changes. CMS recently proposed the Calendar Year 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) Proposed Rule, which would boost Medicare reimbursement for ESRD facilities and refine a new mandatory value-based purchasing program. The proposed […]
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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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5 Ways to Ensure RCM Efforts Don’t Leave Money on the Table

A frequent knock on electronic health records has been that they’re just glorified billing systems that fail to provide enough clinical functionality to make a significant difference in quality of care. So it’s somewhat incongruous that a recent Black Book report on revenue cycle management (RCM) system adoption would say that 26 percent of hospitals […]
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How Cryptocurrency Benefits Medical Billing Services

Cryptocurrency benefits medical billing services, and in turn healthcare staff and patients, in so many ways. Here’s what to know A cryptocurrency is a decentralized virtual or digital currency that’s used as a medium of exchange for using particular products/services. It is like normal currencies but it also facilitates the exchange of digital information. Counterfeiting cryptocurrency is difficult […]
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Medicare Advantage Plans and the Two-Midnight Rule

Controversy continues to swirl around this subject. A recent article of mine focused on the argument that Medicare Advantage (MA) plans have to follow the two-midnight rule. It certainly generated buzz; I received a number of emails with comments and questions. First, I want to note that I love getting comments and questions. I can’t […]
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