The Supreme Court’s decision in California v Texas ended one lawsuit against the Affordable Care Act but may have left room for future legal action. Since the Supreme Court dismissed California v Texas on June 17, payers and healthcare leaders have vocalized their support for the decision, their readiness to continue building on the Affordable […]
CMS will increase Medicare payments by $35 per dose to administer at-home COVID-19 vaccines in an effort to increase the vaccination rate among beneficiaries. Medicare payments will increase by $35 per dose for providers who administer at-home COVID-19 vaccinations for Medicare beneficiaries, CMS announced today. In alignment with President Biden’s goal of ensuring vaccine […]
The COVID-19 pandemic has blown the doors wide open on telehealth, especially with new reimbursement parity policies. But value-based contracts can support the growing interest in remote patient monitoring and other virtual care services beyond the pandemic, according to telehealth experts at the Revenue Cycle Management Summit. “Remote patient monitoring programs are growing,” Andrew […]
Previously delayed from March 15th to May 15th, the final rule will now be codified on December 15th, giving CMS time to tackle issues raised by stakeholders. CMS announced that it will delay the effective date of a final rule updating the definition of “reasonable and necessary” and the guidelines surrounding the Medicare […]
Prior authorization still presents challenges to physicians, three years after the AMA and other health organizations released a consensus statement urging reform. A recent survey from the American Medical Association (AMA) evaluated the challenges and roadblocks of prior authorization (PA) for physicians and patients three years after a coalition of industry groups led by […]
After three years of policy proposals, the American Medical Association Current Procedural Terminology (CPT) panel responses, and substantial guidance from gastroenterology and other specialty societies, changes to the office/outpatient evaluation and management (E/M) codes became effective as of January 2021. Some aspects of these revisions took effect for telehealth services since spring 2020 for […]
At first glance, it appeared that hospitals were complying with the Centers for Medicare & Medicaid Services’ (CMS) price transparency requirement, which became effective January 1, 2021. Upon a closer look; however, multiple deficiencies were found. CMS previously advised that it would begin auditing compliance with the rule this past January. Interestingly, it was the […]
Claims management is a multi-step process that provides ample opportunity for errors and delays, but if payers modify their approach to certain steps in the process it could have a positive impact overall. In the most concise language, claims management starts with a provider sending a claim or prior authorization request to a payer. The […]
Betsy Nicoletti, MS, a nationally recognized coding expert, will take your coding questions via email and provide guidance on how to code properly to maximize reimbursement. Have a question about coding? Send it here. In this column, Nicoletti outlines some key guidance for using telemedicine. These rules would apply during the Centers for Medicare & Medicaid […]
The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update Medicare Advantage plan (MA, or Part C) and the Medicare prescription drug benefit (Part D) program. In years past, CMS has also issued a “call letter,” not subject to the regulatory process, to provide additional information for plans to use […]