Tag: CMS

Emergency Department coding

Emergency Department Coding: Best Practices and Challenges

Table of Contents The Emergency Department Coding Process Unique Challenges of Emergency Department Coding CPT Documentation Updates and Emergency Department Coding ED Facility Coding and National Standards The Limitations of Final Diagnosis-Based Payment ED Utilization and Evolving Treatment Paradigms The Importance of Emergency Department (ED) Coding in Medical Coding Companies Conclusion Emergency Department coding is […]
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Medicare Physician Reimbursement Cuts

Medicare Physician Reimbursement Cuts Threaten Patient Access to Care

With over 67 million Americans—nearly 20% of the population—relying on Medicare, the program plays a crucial role in ensuring access to quality healthcare. Unfortunately, looming Medicare physician reimbursement cuts threaten to undermine this vital service, potentially leading to reduced access to care and compromised patient outcomes Medicare physician reimbursement cuts, such as the proposed 2.8% […]
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ma reform

Medicare Advantage Reform: Rising Scrutiny and Political Shifts

Medicare Advantage (MA) plans, a type of private health insurance that serves as an alternative to traditional Medicare, have long been a subject of debate within the healthcare industry and among policymakers. However, recent political developments suggest a growing appetite for MA reform, marking a significant departure from previous bipartisan consensus. A Rising Tide of […]
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ICD-10-PCS Codes and Guidelines

Latest ICD-10-PCS Codes and Guidelines

The latest ICD-10-PCS codes and guidelines for the fiscal year 2024 have been unveiled by the Centers for Medicare & Medicaid Services (CMS). With a net growth of 73 codes, the total count of inpatient procedure codes has reached 78,603. Notably, the New Technology Section has experienced the largest surge, introducing 40 new codes. The […]
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Medicare payment rules 2025

CMS Unveils Proposed Rules Impacting Medicare Payments for 2025

The Centers for Medicare & Medicaid Services (CMS) has unveiled a series of Medicare payment rules that will dramatically impact Medicare payments for 2025. These changes encompass payment rates, coding guidelines, coverage criteria, and quality measures for various healthcare providers. Physicians, in particular, face a proposed average payment rate cut of 2.93% under the fee […]
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Value based payment

Value-Based Payment: Prioritizing Patient Health Over Profits

Value-Based Payment: Putting Patient Health First: When recommending a medical procedure, should doctors prioritize insurance reimbursements or patient health? The answer hinges on the payment model. In a fee-for-service system, providers are compensated for each individual service, potentially incentivizing excessive care. This model can lead to increased costs and harm patients through unnecessary treatments or medications. […]
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July 2024 OPPS Update

Comprehensive Overview of CMS July 2024 OPPS Update (CR13632)

The CMS Releases July 2024 OPPS Update (reference: CMS Change Request CR13632, MLN Matters number MM13632). Here’s a summary of key changes: New Coverage for COVID-19 Pre-Exposure Prophylaxis: Drug: PEMGARDA (pemivibart) – Code: Q0224 (Note: This code is not reimbursed under OPPS, but at a “reasonable cost”) Administration: Code: M0224 (Covered: Receives separate payment under […]
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compliant coding and billing

Compliant Coding and Billing for Physicians: Expert Tips

The article explores common billing mistakes and offers tips for four healthcare services that can cause payment headaches for physicians. 1. Annual Wellness Visits vs. Physicals: Understanding Medicare Requirements Differentiating between Annual Wellness Visits (AWV) and Initial Preventive Physical Exams (IPPE) is crucial for accurate billing. Both are covered by Medicare for preventive care, but […]
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