Posts Tagged ‘CMS’
CMS Releases FY 2024 IPPS Final Rule: Review Payment Changes Here
The 2024 IPPS Final Rule discusses overall adjustments to IPPS and updates to MS-DRGs, New Technology Add-on Payments (NTAP), and many other changes.
Read MoreCMS announces new ICD 10 codes for vaccination and COVID 19 treatments
In November 2021, the Centers for Medicare & Medicaid Services (CMS) announced new ICD-10 vaccination and treatment codes for 2022.
Read MoreFinal Rule for Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System (CMS-1753FC)
The Centers for Medicare & Medicaid Services (CMS) announced the OPPS/ASC final rule in a press release on November 2, 2021.
Read MoreCMS PEPPER Report to Include Total Knee Arthroplasty (TKA)
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) is a quarterly electronic data report that contains a hospital’s claims data statistics for Medicare Severity Diagnosis-Related Groups (MS-DRGs). CMS has approved the addition of a new target area to the quarterly PEPPER report related to inpatient total knee arthroplasty (TKA).
Read MoreTelemedicine Services Are Here to Stay Thanks to COVID-19, Shows Telehealth Billing Statistics
The number of telehealth visits via real-time audio-video communication, as well as audio-only phone calls, skyrocketed in 2020, telehealth billing statistics show, due to the outbreak of SARS-CoV-2 and stay-at-home orders nationwide. Nearly half (43.5%) of Medicare primary visits were done via telehealth in April, compared to just 0.1% in February prior to the public health emergency (ASPE-HHS, 2020).
Read MoreEverything You Need to Know About the HCC Risk Adjustment Models
There are two different models for Hierarchical Condition Category (HCC) risk adjustments: the HHS-HCC model, which covers commercial payers of all ages and determines risk payments for the current year, and the CMS-HCC model for the Medicare Advantage program and those who qualify for Medicare or patients 65 and older.
Read MoreImplement These Best Practices to Improve HCC Coding
Every healthcare organization that has Medicare patients who receive coverage and benefits through the Medicare Advantage program uses HCC coding. CMS established the HCC coding risk-adjustment model in 2004 to better predict healthcare costs for every patient and increase the accuracy in risk adjustment data for reimbursement claims (CMS, 2004). But, what is HCC coding? Hierarchical condition category (HCC) coding utilizes the ICD-10 code set to identify risks for each patient and assign risk values, or RAF scores, in value-based care models. If your coding team needs HCC coding help, here are 4 HCC coding best practices you can implement right now to see a positive impact immediately.
Read MoreReview the ICD-10-PCS 2021 Updates, Effective 10-1-2020
This article will highlight the ICD 10 PCS 2021 updates and Guideline changes, and briefly present some of the code additions for the Medical and Surgical Section.
Read MoreCMS Guidelines for Telehealth Coding & Billing During PHE
The Centers for Medicare & Medicaid Services (CMS) has decided to update the CMS billing and coding guidelines for telehealth or in-home provider services due to the urgency of the current 2019-Novel Coronavirus (COVID-19) pandemic (CMS, 2020). CMS has broadened the scope for reimbursement for virtual check-ins and other digital communications with patients to safely and effectively respond to this Public Health Emergency (PHE). In the interim, telehealth services will not be limited by program restrictions put in place by Medicare (Federal Register, 2020). Evaluation and management (E/M) service codes cover these remote and communication technology-based services performed by a physician or non-physician practitioner (NPP).
Read MoreMedicare Telehealth Services Now Included In Expanded Payment Protocol
The Centers for Medicare & Medicaid Services (CMS) has decided Medicare will expand its payment protocol for professional Medicare telehealth services provided to beneficiaries in all areas of the country, in all settings. “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health” (CMS, 2020). Due to the current Public Health Emergency (PHE) declared for 2019 Novel Coronavirus (COVID-19), this expansion was considered a necessary step to assist in healthcare reimbursement and only designed to last as long as this emergency
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