Tag: CMS

Comprehensive Overview of CMS July 2024 OPPS Update (CR13632)

The CMS Releases July 2024 OPPS Update (reference: CMS Change Request CR13632, MLN Matters number MM13632). Here’s a summary of key changes: New Coverage for COVID-19 Pre-Exposure Prophylaxis: Drug: PEMGARDA (pemivibart) – Code: Q0224 (Note: This code is not reimbursed under OPPS, but at a “reasonable cost”) Administration: Code: M0224 (Covered: Receives separate payment under […]
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Compliant Coding and Billing for Physicians: Expert Tips

Compliant Coding and Billing for Physicians: Expert Tips

The article explores common billing mistakes and offers tips for four healthcare services that can cause payment headaches for physicians. 1. Annual Wellness Visits vs. Physicals: Understanding Medicare Requirements Differentiating between Annual Wellness Visits (AWV) and Initial Preventive Physical Exams (IPPE) is crucial for accurate billing. Both are covered by Medicare for preventive care, but […]
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Medical Coding Audits: Trends and Guide for Providers

The landscape of medical coding audits is constantly evolving.  Staying informed about these trends and implementing best practices can significantly reduce stress and ensure a smooth audit experience. The Shifting Landscape of Medical Coding Audits Traditionally, medical coding audits felt like a lottery. Providers faced the uncertainty of random reviews, often scrambling to address issues […]
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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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CMS Unveils Contentious Prior Authorization Reform Rule Proposals

CMS Unveils Contentious Prior Authorization Reform Rule Proposals

Physicians and healthcare experts are urging Medicare to lead reforms in the time-consuming prior authorization (PA) process, which often causes delays in patient care. However, they caution against excessive reform, as it could exacerbate the problem rather than improving it. The U.S. Centers for Medicare and Medicaid Services (CMS) have put forth two proposals for […]
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CMS Rules for Coding Emergency Department Claims | Best Practices

CMS Rules for Coding Emergency Department Claims | Best Practices

The Centers for Medicare and Medicaid Services (CMS) has consistently authorized hospitals to establish and utilize their own coding guidelines for emergency department facility claims. CMS makes clear that “[a]s long as the services furnished are documented and medically necessary and the facility is following its own system, which reasonably relates the intensity of hospital […]
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New Medical Billing Codes You Should Know About

New Medical Billing Codes You Should Know About

Physicians need to keep their billing and coding right to ensure seamless reimbursements from payers. Similarly, they should stay updated with the latest coding changes to keep their revenue cycle intact. In addition, running a successful medical practice is a daunting task as the providers need to stay updated with the industry guidelines. The year […]
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