Tag: Medicare Coverage


Differences: Preventive vs. Office Visits in Medical Coding & Billing

Preventive Services Vs Office Visits: It is important to note that Medicare does not cover preventive services in the same manner as commercial payers. Therefore, it is important to know the patient’s policy and insurance coverage. Table A shows a breakdown of the coverage parameters. Understanding the distinction between Preventive Services Vs Office Visits is […]
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Prior-Authorization Issue

Prior authorization issues with Medicare Advantage plans

A new final rule from the Centers for Medicare and Medicaid Services (CMS) will make it harder for Medicare Advantage (MA) plans to require prior authorizations for their coverage The rule comes in the wake of a 2022 report from the Office of Inspector General of the US Department of Health and Human Services that […]
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The Medicare Advantage Bill Was Crafted In Response To Complaints

The bill was crafted partly in response to rising complaints among seniors over aggressive marketing practices for Medicare Advantage plans. U.S. Sens. Maggie Hassan, D-N.H., and Dr. Roger Marshall, R-Kansas, have introduced the bipartisan Medicare & You Handbook Improvement Act, which is meant to ensure that when seniors assess their Medicare coverage options, they have the necessary […]
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Administrative Policies Are Overburdening Providers

Some commercial health insurers are using policies that can delay patient care and create burden for providers, causing relationships with hospitals to worsen, according to a survey by AHA. The association fielded responses from more than 200 hospitals in 2019 and from 772 hospitals between December 2021 and February 2022, creating data that both predates […]
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CMS aims to eliminate delays in new Medicare coverage, expand special enrollment periods

The Biden administration wants to close the gap before new Medicare beneficiaries can get coverage and expand use of special enrollment periods. The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule Friday that updated Medicare enrollment and eligibility rules. One of the key proposals is to provide Medicare coverage a month immediately […]
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Telehealth Update: New Bill Could Provide Much Needed Certainty to Providers and Patients

On Monday, February 7, 2022, U.S. Senators Catherine Cortez Masto, D-Nevada, and Todd Young, R-Indiana, introduced the Telehealth Extension and Evaluation Act, which if passed, would extend several of the telehealth waivers for two years after the end of the federal public health emergency (PHE).  See our previous coverage of telehealth during the COVID-19 pandemic. […]
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COVID-19 Monoclonal Antibody Billing Update

Ever since a public health emergency (PHE) for COVID-19 was declared on Jan. 27, 2020, there has been several new HCPCS Level II codes created for monoclonal antibody (mAb) products and administration. As confusing as all these new codes and billing requirements have been, nothing has caused as much trouble as the latest change for […]
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CMS Accelerates Medicare Beneficiaries’ Access to Innovations

Medicare beneficiaries now have immediate access to innovative medical technology approved by the U.S. Food and Drug Administration (FDA), rather than having to wait for it to clear additional bureaucratic hurdles before coverage is approved. The Medicare Coverage of Innovative Technology (MCIT) final rule issued this week eliminates the time and cost innovators were formerly […]
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