Category: Medical Billing

Surprise Billing Regulation

Congress Provides Relief on Medicare Payment; Passes Surprise Billing

  The $1.4 trillion omnibus legislative package passed by Congress late Monday includes COVID-19 related relief for physicians, imposes new restrictions on surprise billing, and funds the government through fiscal 2021, which ends Sept. 30. The legislation mitigates budget neutrality cuts that would have slashed physician Medicare payment rates by 10.2% and extends the moratorium on the […]
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2021 Medicare Physician Payment Schedule

Final 2021 Medicare Pay Schedule: What Physicians Need to Know

The 2021 Medicare physician payment schedule finalized an AMA-developed approach for less burdensome coding and documenting of office and outpatient evaluation and management (E/M) services. The Centers for Medicare & Medicaid Services (CMS) also extended Medicare payment for many services delivered via telehealth at least until the end of calendar year 2021, but indicated that […]
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COVID-19 Billing

CMS Provides Updated Guidance on Billing For Covid-19 Monoclonal Antibody Treatments

  CMS updated its COVID-19 billing FAQs on October 28 to address billing scenarios for potential monoclonal antibody treatments. The two new FAQs, which appear in section BB. Drugs and Vaccines under Part B, address billing for monoclonal antibody treatments provided in the hospital outpatient setting. CMS notes that if a monoclonal antibody product is granted an […]
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COVID-19 Billing and CS Modifier Updates

Updates on COVID-19 Billing and CS Modifier Audits

The pandemic continues to impact Medicare reimbursement. COVID-19 continues to make news on the regulatory front with two new directives from the Centers for Medicare & Medicaid Services (CMS), centering on testing for the deadly coronavirus and formal coding edits for the Medicare Administrative Contractors (MACs) on payments with the CS modifier. There’s a new […]
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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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2021 MPFS & Policy Upda tes

A View into Proposed Medicare PFS and Policy Changes for 2021

  The Centers for Medicare & Medicaid Services (CMS) in the past week has proposed Medicare payment rules for outpatient services and physicians for 2021 and finalized payment rules for inpatient rehabilitation facilities (IRFs) and psychiatric facilities. Looking specifically at the 2021 Physician Fee Schedule (PFS) proposed rule, scheduled to be published Aug. 17, it […]
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Medicare Billing Updates

CMS Updates Medicare Billing Rules for 20% Add-On COVID-19 Payment

  In addition to Medicare billing updates, the federal agency also announced that it will resume routine inspections for all Medicare and Medicaid-certified providers. Claims eligible for the 20 percent add-on payment for COVID-19 hospitalizations will now have to have a positive laboratory test documented in the patient’s medical record, according to recent Medicare billing […]
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Billing and Documentation Guide

Billing and Documentation Guide for Patient Care During COVID-19 Pandemic

  The COVID-19 pandemic has brought about robust changes to the traditional practice of healthcare in the United States. In a time of social distancing and widespread quarantining, regulatory bodies, including the Centers for Medicare & Medicaid Services (CMS), have adapted to the current environment. The most critical goal was to allow healthcare providers to […]
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