Posts Tagged ‘CMS’
CMS Clarifies Risk Adjustment Criteria for Coding Telehealth Services
CMS clarified on April 10, 2020, that the submission of ICD-10-CM diagnoses codes for Risk Adjustment are permitted from coding telehealth services as long as it meets the set criteria (i.e. inpatient, outpatient, or professional service and from a face-to-face encounter) (CMS, 2020). CMS is stating that telehealth services can meet the face-to-face requirement “when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication” (2020). From a medical coding and billing standpoint, the change in the telehealth services criteria for risk adjustment is causing updates to how these services are billed.
Read MoreUpdates Coming to the Quality Payment Program in 2020
In the 2020 Medicare Physician Fee Schedule Final Rule released by the Centers for Medicare and Medicaid Services late last year, several changes were made to the value-based Quality Payment Program (QPP) to simplify the rules for providers. These updates will “impact more than 1 million clinicians eligible for one or both of the QPP’s two performance tracks, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). CMS estimates that 880,000 clinicians will be MIPS-eligible in 2020, and between 210,000 and 270,000 clinicians will achieve Qualifying APM Participant (QP) status in 2020.”
Read MoreSelecting the Right COVID-19 Code: Should You Use CPT or HCPCS?
On March 11, the World Health Organization (WHO) issued a declaration of the COVID-19 as a global pandemic. Two days later, the AMA announced the development of a specific code for laboratory testing for the coronavirus, code 87635 (AMA, 2020). The Centers for Medicare and Medicaid Services (CMS) released two new HCPCS codes for coronavirus testing for Medicare claims. The reporting for COVID-19 testing is dependent on the payer, either an HCPCS or CPT code should be used; there should not be more than one COVID-19 testing code on a given claim.
Read MoreNew COVID-19 MS-DRG Assignment, Effective April 1
ICD-10-CM code U07.1 COVID-19 will be in effect as of April 1 in the US, which was pushed up from the normal effective date of October 1 for new codes. The reasoning for this unprecedented change is for the urgent need of immediate data collection. CMS has released a new update on 3/23/2020: “The ICD-10 MCE Version 37.1 R1 uses edits for the ICD-10 codes reported to validate correct coding on claims for discharges on or after April 1, 2020″ (2020). The ICD-10 MS-DRG Grouper software package to accommodate this new code, Version 37.1 R1, is effective for discharges on or after April 1, 2020.
Read MoreTop 8 Changes Medicare Payment Systems Will See In 2020
The Centers for Medicare & Medicaid Services (CMS) is implementing 8 major changes this year to the Medicare payment systems, according to Becker’s ASC Review (2019). A majority of these changes come from the organization’s 2020 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System Final Rule (CMS, 2019). Other changes were due to the finalization of the CY 2020 Medicare Physician Fee Schedule Final Rule (CMS, 2019).
Read MoreChanges to Appropriate Use Criteria for Advanced Diagnostic Imaging
Starting January 1, CMS began testing the condition for Appropriate Use Criteria (AUC) requiring a qualified Clinical Decision Support Mechanism (CDSM) consultation by a qualified provider for payment on Advanced Diagnostic Imaging for Medicare beneficiaries. Claims must include the ordering professional’s NPI, which CDSM tool was utilized for the consultation, and “whether the service ordered would or would not adhere to consulted AUC or whether consulted AUC was not applicable to the service ordered” (Medicine Learning Network, 2018). The program will be fully implemented by January 1, 2021.
Read MoreNeed Medicare Learning Resources? The CMS Wheel Can Help
Navigating the Center for Medicare & Medicaid Services (CMS) rules can be tricky. It can be handy to have a fact sheet that goes over a variety of CMS topics. We recommend you use this interactive Medicare learning resource!
Read MoreNew Medicare Cards Replace the SSN-based Health Insurance Claim Number
The Center for Medicare & Medicaid Services (CMS) has officially started to mail new Medicare cards to beneficiaries. The new cards will use a unique, randomly assigned number called a Medicare Beneficiary Identifier (MBI) to replace the SSN-based Health Insurance Claim Number (HICN) currently used on Medicare cards. The law requires the Department of Health and Human Services (HHS) to issue new Medicare cards that do not display, code, or embed SSNs by April 2019.
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