Category: Blog

ahip-warns-proposed-aca-exchange-rule-could-threaten-markets-growing-stability

AHIP warns proposed ACA exchange rule could threaten market’s growing stability

  AHIP, the top lobbying organization for commercial insurers, is warning the feds that provisions in its proposed rule governing the Affordable Care Act’s exchanges for 2023 could “undermine” the growing stability there. For instance, the group says in comments (PDF) submitted late Thursday that potential changes to requirements for essential health benefits would limit […]
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Surprised Providers Seek Changes to Latest Provisions of the No Surprises Act

Effective January 1, 2022, new billing protections went into effect that have the goal of providing greater protections for patients against surprise medical bills. The Departments of Health and Human Services, Labor, and Treasury, and the Office of Personnel Management (collectively, the Departments) implemented these additional protections that are part of the No Surprises Act […]
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Rural Health Clinic Policies Revised

  Don’t send another RHC claim until you’ve reviewed these key changes for 2022. A Rural Health Clinic (RHC) is a clinic located in a rural, underserved area with a shortage of primary care providers, personal health services, or both. Medicare pays RHCs for the provision of certain primary care and preventive health services in […]
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$2B in Provider Relief Fund Payments Heading to Providers

The Provider Relief Fund payments are part of the Phase 4 General Distribution announced in December. HHS, through the Health Resources and Services Administration (HRSA), is doling out another $2 billion in Provider Relief Fund payments to healthcare providers impacted by the COVID-19 pandemic. More than 7,600 providers across the country will get the payments […]
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cms-proposes-changes-to-medicare

CMS Proposes Changes to Medicare Advantage and Part D Programs

On January 12, the Centers for Medicare & Medicaid Services (CMS) released the Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule, representing CMS’ first major policy proposals for these programs in the Biden Administration. The changes proposed are, overall, modest in scope. In the […]
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More ICD-10-PCS Codes Released for April 2022

  There are 200 new codes, 62 revised titles, and 107 deleted codes. The Centers for Medicare & Medicaid Services (CMS) released a new erratum for ICD-10-PCS on Jan. 12. Two additional procedure codes will be effective April 1, 2022. These codes have also been added to V39.1, Medicare Severity Diagnosis Related Groups (MS-DRGs). The […]
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medical-decision-making-and-coding

Medical decision making and coding

MDM elements during a preventive visit Q: Is it appropriate to count laboratory tests and other tests ordered during a preventive medicine service (99381-99397) visit in medical decision making (MDM) selection? No, because the 2021 revisions to the E/M office or other outpatient MDM do not apply to codes 99381-99397 (preventive services). These codes are […]
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ama-challenges-medpac-suggestion-to-freeze-medicare-physician-payment

AMA Challenges MedPAC Suggestion to Freeze Medicare Physician Payment

The industry group states that Medicare physician payment bump will hinder the delivery of high-quality care as providers face financial burdens. MedPAC, a panel tasked with advising Congress on issues impacting the Medicare program, voted to recommend no increase to 2023 Medicare reimbursement rates for physicians. “Temporary or high variable coronavirus effects are best addressed […]
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