Tag: HCPCS Codes

Reimbursement-methodology

Understanding Medical Codes and Reimbursement Methodologies

The Role of Medical Codes in Reimbursement Methodologies: Medical codes, such as CPT, HCPCS, and ICD-10 (CM and PCS), are essential components of various reimbursement methodologies. The Inpatient Prospective Payment System (IPPS), used by Medicare fee-for-service, categorizes patient stays into Medicare Severity Diagnosis Related Groups (MS-DRGs) based on ICD-10 codes processed through a computerized system. […]
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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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Challenges in Insurance Reimbursement

Top 4 Challenges in Insurance Reimbursement Faced by Physicians

Access to beneficial healthcare is largely tied to insurance reimbursements for many Americans. Yet, despite their significance, physicians encounter various obstacles in obtaining these payments. Challenges involve inconsistent reimbursement schedules, payment audits, billing errors, unforeseen denials, lengthy appeals, and services falling outside coverage. These issues can hinder timely care, disrupt service continuity, and leave medical […]
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Tips-To-Maximize-Medical-Billing-and-Coding-Efficiency

Tips To Maximize Medical Billing and Coding Efficiency

Ensuring precise claims processing and prompt reimbursements, healthcare practitioners rely heavily on efficient medical billing and coding procedures. The act of streamlining these functions holds the potential to not only heighten overall effectiveness but also to curtail administrative burdens and mitigate the risk of errors. Within this article, we will delve into a selection of […]
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CMS-Corrects-Time-Thresholds-for-Prolonged-Services

CMS Corrects Time Thresholds for Prolonged Services

What a difference 15 minutes can make when billing E/M services. The Centers for Medicare & Medicaid Services (CMS) issued a notice March 14 correcting several errors in the 2023 Medicare Physician Fee Schedule (MPFS) final rule. Most notably, CMS is correcting technical errors in the calculations of the time thresholds for reporting evaluation and […]
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Check-Out-New-Codes-for-Reporting-Services

Check Out All the New Codes for Reporting Services

Don’t assume the codes you’ve been using to report drugs and biologicals still apply. The January 2023 update to the HCPCS Level II code file from the Centers for Medicare & Medicaid Services (CMS) includes 184 new codes for reporting services and supplies. Approximately 36 of the new codes were created to separately identify products […]
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New-Coding-Classifications-for-2023

New Coding Classifications for 2023

Update your facility-specific guidelines accordingly for 2023. Although the new calendar year is not the beginning of the federal fiscal year, there are coding classifications and terminologies that changed on Jan. 1, 2023. Current Procedural Terminology® (CPT) and Healthcare Current Procedure Coding System (HCPCS) have releases that went out on Jan. 1. There are also […]
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2023-Telehealth-Service-Codes

The 2023 Telehealth Service Codes Physicians Need to Know

Question: Could you kindly provide us with the updated telehealth services codes for the year 2023? Response: Regarding Medicare Telehealth Services for the year 2023, the Centers for Medicare and Medicaid Services (CMS) are introducing fresh Healthcare Common Procedure Coding System (HCPCS) codes to the compilation of Medicare telehealth services. More precisely, the subsequent HCPCS […]
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2023-MPFS-and-Quality-Payment-Program-Final-Rule-Released

2023 MPFS and Quality Payment Program Final Rule Released

The conversion factor is down but certain public health emergency flexibilities will continue. The 2023 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program final rule, released Nov. 1, allows Part B physician payment for behavioral healthcare, cancer screening, and dental care. But while the Centers for Medicare & Medicaid Services (CMS) continues its focus […]
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CPT®-and-HCPCS-Newly-Added-and-Revised-Codes

CPT® and HCPCS Newly Added and Revised Codes

CPT® codes are effective Jan. 1, 2023. The American Medical Association (AMA) released CPT 2023 on Sept. 12. There are 225 new codes, 75 deletions, and 93 revisions. Most of the changes fall in the Evaluation and Management (E&M) section. The 2023 CPT codes are effective Jan. 1, 2023. The October 2022 release of the […]
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