Medical Coding & Billing Tips for COVID-19

COVID-19

With the number of COVID-19 (2019-Novel Coronavirus) cases expected to rise in North America, the Centers for Medicare & Medicaid Services (CMS) has provided information on how to medically code and bill all encounters related to COVID-19 for Medicare beneficiaries (CMS, 2020).

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Top 8 Changes Medicare Payment Systems Will See In 2020

Medicare Payment Systems

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).

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Changes to Appropriate Use Criteria for Advanced Diagnostic Imaging

Appropriate Use Criteria

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.

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New Medicare Cards Replace the SSN-based Health Insurance Claim Number

new Medicare cards

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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