Tag: CMS

New Billing Basics for Telemedicine

New Billing Basics for Telemedicine

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 […]
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Medicare Advantage and the Medicare Drug Plan

New Directions for Medicare Advantage and the Medicare Drug Plan in 2021

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 […]
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New Rules from CMS

More New Rules from CMS for FY 2020

Among the proposed new rules is one intended to clarify the contentious “Stark Law” On Oct. 9, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modernize and clarify the regulations that interpret the Medicare physician self-referral law (often called the “Stark Law”). The law prohibits physicians from making referrals for […]
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HCPCS Level II Coding Cycles and Procedures

CMS Implements Significant Updates to HCPCS Level II Coding Cycles and Procedures

The Centers for Medicare & Medicaid Services (CMS) announced that, beginning in January 2020, CMS will implement shorter and more frequent HCPCS Level II coding  cycles for requests to modify the Healthcare Common Procedure Coding System (HCPCS) Level II code set. Under the updated procedures, stakeholders will be able to submit code applications on a quarterly basis […]
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Preparing for ICD-11

HCC Coding: Preparing for ICD-11

HCCs thrive on specificity and ICD-11 will provide a higher level of specificity than in ICD-10. For those of you who are HCC coding for hierarchical condition category (HCC) purposes, you know that HCCs are categories of related ICD-10 codes. Only selected significant conditions to drive a payment HCC coding. That means only conditions that […]
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EM Code

Final Physician Payment Rule Keeps E/M Code Changes

CMS on Friday issued its 2020 final rules for the Physician Fee Schedule, including a streamlining of evaluation and management services (E/M) reporting that was rolled back from an earlier proposal in a change providers applauded. The final rule, which is mostly unchanged from the proposed rule put forward in July, also cuts payments to physical therapists […]
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Outpatient Proposals

2020 Outpatient Proposals: 5 Rules You Should Know From CMS

Hospital and health system executives should monitor these proposals for provisions that will affect their organizations’ operations. The 2020 annual rule cycle has been active for CMS. Several proposals in the outpatient prospective payment system (OPPS) proposed rule is controversial, although there is at least one provider-friendly change. Here’s a roundup of five regulatory rules […]
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Medicare Retires G Codes for Mammograms

Medicare Retires G Codes for Mammograms

Ensure that your practice’s medical coding for preventive screening mammograms aligns with the most recent guidelines during Breast Cancer Awareness Month in October. Coding Mammograms for Medicare The Centers for Medicare & Medicaid Services (CMS) now acknowledges the CPT® mammogram codes, aligning with industry standards. This streamlines the process for coders to accurately document mammogram […]
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