In the complex world of insurance and healthcare claims, the concept of “zero-paid claims” can feel like a phantom menace. You’ve submitted a claim, received an Explanation of Benefits (EOB) or remittance advice, and to your dismay, the payment is… zero. While a zero payment might seem innocuous, it can, in certain scenarios, be interpreted […]
The Centers for Medicare & Medicaid Services (CMS) has unveiled a series of Medicare payment rules that will dramatically impact Medicare payments for 2025. These changes encompass payment rates, coding guidelines, coverage criteria, and quality measures for various healthcare providers. Physicians, in particular, face a proposed average payment rate cut of 2.93% under the fee […]
Medicare Conversion factor are up but payouts are still down compared to last year. Healthcare professionals will see a slight upward adjustment to their Medicare payments starting March 9 after President Biden signs the Consolidated Appropriations Act (CAA), 2024. Really fortunately, although the 2024 CAA increases the conversion factor (CF) finalized for calendar year (CY) […]
The Senate Finance Committee proposed that the full chamber should review a legislation that could instigate alterations in physician practices. This proposition was discussed during a 90-minute meeting on November 8, 2023, regarding the bill named “The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act.” This bill encompasses diverse aspects of healthcare, including mental […]
The difference between a financially and clinically successful practice and one that is struggling often comes down to whether they have the code right and document thoroughly. Changes in 2021 to major coding categories, such as evaluation and management (E/M) coding for office visits means major change that can hamper your operations if not done […]
CMS released the fiscal year (FY) 2023 inpatient prospective payment system proposed rule with proposals for new calculations for FY 2023 rate setting. Although CMS is proposing to use FY 2021 data for FY 2023 Medicare Severity Diagnosis-Related Groups (MS-DRG) rate setting, the agency wants a modified methodology to account for the historical and potential […]
CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2023 (the Proposed Rule). In the Proposed Rule, CMS proposes to update the IPPS and LTCH payment rates, modify the payment rules for direct graduate medical education (DGME) to comply with a recent […]
Don’t send another RHC claim until you’ve reviewed these key changes for 2022. A Rural Health Clinic (RHC) is a clinic located in a rural, underserved area with a shortage of primary care providers, personal health services, or both. Medicare pays RHCs for the provision of certain primary care and preventive health services in […]
New COVID-19 vaccine status codes, changes and corrections to the 2022 CPT code set, Medicare Physician Fee Schedule (MPFS) payment changes, and prior authorization code list changes — that’s what’s on the agenda this month. Read all about it! 3 New Codes Improve COVID-19 Vaccination Status An April 1, 2022, update to the 2022 ICD-10-CM […]
The news coincided with the sudden worldwide emergence of the new omicron COVID-19 variant. An influx of cash couldn’t have come at a better time for the nation’s rural healthcare system. The U.S. Department of Health and Human Services (HHS) last week announced that the Health Resources and Services Administration (HRSA) has begun distributing $7.5 […]