Category: Blog

Home Dialysis Medicare Payment

CMS Finalizes Payment Model Aimed At Boosting Access to Home Dialysis, Kidney Transplants

The Trump administration has finalized a rule aimed at boosting access to home dialysis and translation for patients with end-stage renal disease. The Centers for Medicare & Medicaid Services estimates that the End-Stage Renal Disease Treatment Choices Model will save Medicare $23 million over the next five years. The value-based model is designed to incentivize providers to […]
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2021 Coding Rules

New Medical Coding Rules for E M Visits

Q: Do the new 2021 coding rules for office visits apply to all payers or just Medicare and Medicaid? Also, are these rules just for office visits, or can we use them for hospital visits, nursing home services, and home visits? A: The changes to the documentation requirements are for codes 99202-99215 only and are […]
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In-patient COVID-19 Billing

CMS Revises Billing Instructions for Inpatient Covid-19 Claims

CMS provided clarification on submitting inpatient claims for patients diagnosed with novel coronavirus (COVID-19) without a positive viral test, in an update to MLN Matters SE20015 released September 11. Earlier this year, the CARES Act increased the MS-DRG weighting by 20% for a COVID-19 diagnosis. Although the CARES Act doesn’t specify that the diagnosis must be supported by a […]
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Billing Cycle

Take a Consumer-Oriented Approach to Your Billing Cycle

The Covid-19 pandemic is transforming how physicians practice medicine and bill for it. Physicians who take a consumer-oriented approach to their billing cycle may adapt the best, says John Behn III, MPA, president of Stroudwater Revenue Cycle Solutions and a principal of Stroudwater Associates, a national healthcare consulting firm based in Portland, Maine. “We’ve seen […]
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Patient Collection Tips

Nine Tips for Collecting Patient Balances

Practices have been creative during COVID-19 to ensure safe patient access: Telephone visits. Curbside immunizations. Drive-up virus testing. Even checking patients in for their in-office visits while they wait in the car. However, each of these scenarios poses one significant challenge: Collecting copayments and coinsurance. “With COVID-19, you’ve got to find ways to meaningfully engage […]
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2020 Coding Guide

2020 Coding Guide: Get Paid What You’re Owed

  There’s nothing more frustrating than rendering a service and not being paid. Sometimes the problem comes down to a single code. Nuanced coding rules are difficult to understand, and physicians aren’t taught this information in medical school. Still, health care is a business. As business owners, physicians need to know how they’re paid, including […]
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New COVID-19 Codes

New COVID-19 Codes Coming

  Twice a year, in March and September, the Centers for Medicare & Medicaid Services (CMS) ICD-10 Coordination and Maintenance (C&M) Committee meets, and the public is encouraged to participate. I personally find it extremely rewarding. I feel like I am contributing to the evolution of the ICD-10-CM code set. I had aspired to attend […]
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Medicare MIPS

MIPS Proving a Financial Boon for System-Affiliated Doctors

Doctors looking to earn more under Medicare’s Merit-based Incentive Payment System (MIPS) would likely benefit from working in a practice affiliated with a hospital system. A recently-published study in JAMA finds that doctors in system-affiliated practices earned substantially higher MIPS scores in 2019 than those in independent practice, and were thus more likely to receive upward payment adjustments and […]
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Clinicians Disadvantages under MIPS

Clinicians Serving Socially At-Risk at a Disadvantage Under MIPS

  Clinicians who served more patients with social risk factors such as low income performed worse in the Merit-Based Incentive Payment System’s inaugural payment year, and therefore, received unfavorable value-based reimbursement, according to a new study. The study recently published in Health Affairs found that out of 510,020 clinicians participating in the Merit-Based Incentive Payment System (MIPS) in […]
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