Tag: Medicare

New Patient EM Denials

New Patient E/M Denials: Mystery Solved

New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
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Understanding Why 99201 Will be Deleted

Understanding Why 99201 Will be Deleted

An overview of the proposed Medicare Physician Fee Schedule: The proposed Medicare Physician Fee Schedule (MPFS) rule for 2020 was officially released on Aug. 14, 2019, encompassing various elements. Among these are proposals such as adjusting the PFS conversion factor to $36.09, introducing new HCPCS codes for bundled episode-of-care treatment for opioid use disorders, revising […]
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Medicare Advantage Plan Denials

Medicare Advantage Plan Denials: Is That Convoluted or What?

Medicare Advantage Plan contracts are “take-it-or-leave-it” agreements Many questions are swirling about regarding Medicare Advantage Plan (MAP) denials asking what to do about the increasing number and given reasons.  I’ve heard or read some amazing stories where payers have gone to astounding lengths to deny claims.  Answers are also swirling about based on understandings of […]
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Medicare Beneficiary Identifiers

The New Medicare Cards: What You Need to Know About Medicare Beneficiary Identifiers (MBIs)

To protect the privacy of Medicare recipients and prevent fraudulent use of Social Security Numbers (SSN), a new, unique 11-character Medicare Beneficiary Identifier (MBI) is replacing the SSN-based Health Insurance Claim Number (HICN) for Medicare transactions such as billing, eligibility status, and claim submissions. The MBI does not change Medicare benefits. What’s Behind The Change? The […]
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Healthcare Remains Primary Concern for Voters, with Strong Support For ‘Medicare-For-All’

Healthcare is a top priority for American voters and there aren’t dramatic differences by ideology, according to a new survey. Key Takeaways Thirty six percent of Americans ranked healthcare as the most important policy issue facing the nation’s future. Seventy two percent of Americans responded that they were satisfied with the healthcare they received while […]
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Psychiatric Facilities

Psychiatric Facilities Could See Payments of $75 Million In 2020

CMS has released the inpatient psychiatric facility proposed rule. Approximately $75million is projected to be paid to inpatient psychiatric facilities (IPF), according to the Centers for Medicare & Medicaid Services (CMS) proposed 2020 inpatient prospective payment system (IPPS) released on April 19. IPF-PPS applies to inpatient services for psychiatric hospitals and distinct psychiatric units of […]
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HCPCS and CPT Codes

What’s New In 2019 For CMS

This year’s reporting for the Quality Payment Program will affect the 2021 payment year. Kevin J. Corcoran, COE, CPC, CPMA, FNAO, delivered his annual update at Hawaiian Eye 2019, highlighting changes CMS would be making this year for coding, payment issues, regulatory matters, administrative issues and reimbursement issues. The Medicare Physician Fee Schedule did not […]
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New Rules Issued for Modifiers 59, XE, XS, XP, and XU

New Rules Issued for Modifiers 59, XE, XS, XP, and XU

The Centers for Medicare & Medicaid Services (CMS) issued a policy change modification to the claims processing logic for Modifier 59 Distinct procedural service (and the optional patient-relationship modifiers XE, XS, XP, and XU) on February 15, 2019. These modifiers are only processed when applied to the Column 2 code in a bundled pair, per Correct Coding Initiative […]
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