Category: Revenue Cycle Management

CMS-rules-for-payer-provider

CMS To Repeal Public Disclosure Of Payer-Provider Negotiated Rates

The Centers for Medicare & Medicare Services on Tuesday unveiled a sweeping proposed rule that would nullify the mandated public disclosure of negotiated rates between payers and providers and increase by 2.8% Medicare’s inpatient prospective payment in fiscal year 2022. “The rule’s provisions seek to sustain hospital readiness to respond to future public health threats, […]
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hospital-payment-increase-under-cms-rule

Hospital Payments Increase 2.8% Under CMS Proposed Rule

The Centers for Medicare and Medicaid Services has updated the Medicare fee-for-service payment rates and policies for inpatient hospitals and long-term care hospitals for 2022. Before taking into account Medicare disproportionate share hospital payments and Medicare uncompensated care payments, the proposed increase in operating payment rates, increases in capital payments, increases in payments for new […]
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revenue-code-for-covide-19-monoclonal-antibody-fusion

Determining Revenue Code for COVID-19 Monoclonal Antibody Infusion

The COVID-19 monoclonal antibodies are being paid under the vaccine benefit. Q: What revenue code should be attached to HCPCS codes M0239 (intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring) and M0243 (intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring)? We set it up as revenue code 260 but are getting […]
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Medicare Radiology Payment System

Health Policy Experts Offer 3 Fixes for Medicare’s ‘Dysfunctional’ Advanced-Imaging Payment System

  Medicare Radiology Payment System approach to advanced imaging reimbursement has been “dysfunctional” for decades, but health policy experts have a few suggestions to fix it. Over the past 20 years, the federal payment program witnessed “substantial” increases in the performance of MRIs, CT scans and nuclear studies, mostly in doc offices. A shift later […]
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Price Transparency Rule Requirement

New Federal Transparency Requirements Impacting Health Providers and Plans

As promised, this is a follow-up to our first blog post on the new federal transparency requirements. In our prior post, we summarized the Hospital Price Transparency rule which went into effect on January 1, 2021, and here we discuss the transparency rules contained in the Consolidated Appropriations Act, 2021 (the “Act”), which apply to both health plans […]
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Physician’s Prior Authorization burden

Prior Authorization Burden Still High Despite COVID Struggles

Most physicians still faced a high prior authorization burden despite treating a surge of positive COVID-19 cases this winter, the American Medical Association (AMA) reports. In a survey of 1,000 practicing physicians between Nov. 23, 2020, and Dec. 14, 2020, AMA found that 85 percent of physicians described the burden associated with prior authorization as high […]
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