The introduction of 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) in the United States has produced an influx of patients into the health care system. While knowing how to diagnose and treat these patients is vital, being able to appropriately capture this information for data tracking and payment also is important. The National Center for Healthcare Statistics has […]
The CPT Editorial Panel approved a new CPT code that will support data-driven resource and allocation planning during the novel coronavirus outbreak. The American Medical Association (AMA) recently announced that the CPT Editorial Panel approved a new Current Procedural Terminology (CPT) code for a novel coronavirus test. “In the face of the COVID-19 pandemic, the […]
Medicare reimbursement for COVID-19 tests will be about $36 for the CDC test and $51 for those created in house or by other entities. Following the development of new billing codes, CMS is now letting clinical laboratories know how much they will receive in Medicare reimbursement for COVID-19 testing patients. CMS emailed providers last week […]
Two HCPCS billing codes will allow clinical laboratories and other providers to bill for certain coronavirus lab tests and support testing and tracking of new cases. CMS recently announced the development of new billing codes for coronavirus lab tests that will enable clinical laboratories and other providers to receive reimbursement for supporting patients during the outbreak and […]
The 2019-2020 influenza season is winding down, so now is a good time to start preparing for the 2020-2021 influenza season. Let’s start with a new CPT® code for the flu vaccine. Flu Activity Report The Centers for Disease Control and Prevention (CDC) reports that viral activity is decreasing in the United States. According to […]
CMS has released several fact sheets in recent weeks on billing and coding to provide guidance to healthcare organizations testing and treating patients for COVID-19, the disease caused by the novel coronavirus. Seven things to know: CMS developed Healthcare Common Procedure Coding System code U0001 to allow laboratories and healthcare providers to bill for using the CDC’s […]
On Dec. 31, 2019, as many of us here in the U.S. were celebrating New Year’s Eve, a pandemic quietly began in the Chinese province of Hubei. First identified in Wuhan, the provincial capital, coronavirus (more accurately known as COVID-19 or 2019-nCoV) has spread rapidly in the two ensuing months, resulting in infections, and even […]
![Modifier 59 vs. X[ESPU] Modifiers](https://www.allzonems.com/wp-content/uploads/2020/03/Modifier-59-vs.-XESPU-Modifiers.jpg)
Failure to adopt the X[ESPU] modifiers may be putting your practice at risk for Medicare fraud. Modifier 59 Distinct procedural service continues to be the most-used modifier among Medicare Part B providers, according to Novitas, and it is sending up red flags for possible Medicare fraud and abuse. Representatives from the Medicare Administrative Contractor (MAC) […]
More changes are likely coming. As many of you have heard, there are major changes coming to evaluation and management (E&M) codes in 2021. The changes were finalized in the 2020 Physician Final Rule. The good news is that the Centers for Medicare & Medicaid Services (CMS) gave us all a year to prepare. I […]
In November 2019, CMS published the 2020 Quality Payment Program Final Rule (the “2020 MIPS Final Rule Changes”). Below is a summary of some of the most notable changes to the Merit-Based Incentive Payment Program (MIPS). For a complete list of changes, please review the 2020 MIPS Final Rule or CMS’ Quality Payment Program Resource […]