Posts Tagged ‘Medicare’
Differentiating Between IPPE (G0402), AWV (G0438/G0439), and Annual Physical (99381-99397)
Medicare offers various preventive services to help beneficiaries maintain their health. Understand the differences between the Initial Preventive Physical Examination (IPPE), Annual Wellness Visit (AWV), and the routine annual physical exam.
Read MoreNavigating the Maze: Similarities and Differences of Coding Medicare vs Medicaid Claims
Medicare and Medicaid offer seemingly similar coverage but present distinct coding requirements. This article serves as your guide, demystifying the similarities and differences between these essential programs and their respective coding guidelines.
Read More“Does Your Documentation Meet the M.E.A.T. Criteria?” Presentation by Karen Youmans at 2021 Southeastern Health Data & Information Conference
“Does Your Documentation Meet the M.E.A.T. Criteria?” Presentation by Karen Youmans at 2021 Southeastern Health Data & Information Conference (Quad21) Karen Youmans’ presentation at the Quad21 (Southeastern Health Data…
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 More2021 Medicare Physician Fee Schedule Final Rule Concludes Office/Outpatient E/M Code Updates
The Centers for Medicare & Medicaid Services (CMS) released their Final Rule for the 2021 Medicare Physician Fee Schedule on December 1, 2020 (CMS, 2020). All eyes have been on the Final Rule for a finalization on the much-anticipated office/outpatient Evaluation and Management code updates.
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 MoreYour Quick Guide to HCC Risk Adjustment Models
There are two different Hierarchical Condition Category (HCC) models used to calculate risk adjustments: the CMS-HCC model and the HHS-HCC model. Does your facility know how and when to use them? Our detailed HCC risk adjustment infographic explains the differences and usages for each HCC model.
Read MoreEleven New Telehealth Services Added to Medicare Reimbursement List
CMS has added 11 new services to the Medicare telehealth services list. These new services focus on specific neurostimulator analysis and programming, and cardiac and pulmonary rehabilitation (CMS, 2020). There have been over 135 services added to the list of payable Medicare telehealth services since CMS started expanding Medicare coverage, including ED visits and inpatient encounters. Review our Telehealth Resource Center for the full list of revised coding and billing guidelines for COVID-19. If your facility is struggling with deciphering the revised telehealth guidelines, contact YES HIM Consulting for coding support from our HIM-credentialed experts.
Read MoreWebinar Recap for HCCs background and a deeper dive into M.E.A.T. Criteria
In conjunction with TruCode’s Educational Series of free webinars, YES President and CEO, Karen Youmans hosted a webinar focused on HCC education and coding, and the application of the M.E.A.T. Criteria. The webinar, which was held twice due to popular demand, was attended by over 3,000 HIM professionals. If you missed the opportunity to attend either session, you can download the presentation slides here. We will recap the main points made during the webinar, and provide additional resources to help you and your organization become HCC experts.
Read MoreUpdates for Medicare Fee For Service (FFS): CMS MLN Matters Special Edition Article
The Centers for Medicare & Medicaid Services (CMS) has updated Special Edition (SE) MLN Matters® article SE20011 Medicare Fee for Service response to address the changes made for the issuance of additional guidelines and waivers regarding the 2019 Novel Coronavirus, COVID-19 (CMS, 2020). This MLN Matters® Special Edition Article is for providers and suppliers who bill Medicare Fee For-Service (FFS). This includes blanket waivers for providers and suppliers, a CMS telehealth video regarding coverage of services, guidance on Beneficiary Notice Delivery, and expansion of Ambulance origins and destination modifiers.
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