Tag: CPT Codes

cms-prior-authorization-operational-and-financial-impact

CMS Prior Authorization—operational And Financial Impact

CMS has expanded the prior authorization requirement to two new service categories within hospital outpatient department services. The Centers for Medicare & Medicaid Services (CMS) has expanded the prior authorization requirement for two additional hospital outpatient department (OPD) services. Effective with date of service July 1, 2021, CMS has expanded the prior authorization requirement to […]
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differentiating-hcpcs-levels-i-and-ii-code-sets

Differentiating HCPCS Levels I and II Code Sets

Deciding which code to use starts with determining each payer’s policy. The Healthcare Common Procedure Coding System (HCPCS) has two principal subsystems, referred to as Level I and Level II. Knowing when to use HCPCS Level I codes versus HCPCS Level II codes can be confusing, mainly because many services are described by both code […]
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how-to-increase-provider-utilization-of-remote-patient-monitoring

How to Increase Provider Utilization of Remote Patient Monitoring

Increasing provider utilization in remote patient monitoring starts with effective backend processes and leaning into technologies that they already trust. Remote patient monitoring (RPM) took off during the coronavirus pandemic, but the industry will have to take decisive steps in order to build on that momentum, according to Eric Wicklund, senior editor of mHealthIntelligence. Remote […]
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prolonged-services-in-cpt-versus-medicare-allzone

Prolonged Services in CPT versus Medicare

The code 99417 is invalid for Medicare and MA reimbursement. When the CPT® Guidelines were updated for 2021, one of the options for leveling an office or other outpatient evaluation and management (E&M) service was to use time as the leveling agent. The time thresholds for each E&M office visit were also changed from “typical” […]
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ensuring-data-integrity-and-protecting-your-organization

Ensuring Data Integrity and Protecting Your Organization’s Bottom Line

Part IV in this series discusses expanding HIM’s visibility and enhancing organizational processes via authorization denial management. In my prior article, I discussed the value of payer policy management, and mentioned that “no authorization” denials represent 10-15 percent of all denials. This focused denial category presents another opportunity for health information management (HIM) professionals. HIM […]
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COVID-19 Vaccination Reimbursement

Physicians Call for Fair Reimbursement for COVID-19 Vaccines

  Physicians are asking for adequate reimbursement for all COVID-19 vaccines and their administration, according to a new policy statement from the American College of Physicians (ACP). The statement released on Jan. 12 calls on health policymakers to require insurers to “provide adequate reimbursement for all vaccines, including COVID-19 vaccines, administered according to” scientific guidelines established by […]
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