Tag: HCPCS Codes

cms-repeals-final-rule-digital-therapeutics-year-shifting-guidance

CMS Repeals Final Rule on Digital Therapeutics in A Year of Shifting Guidance

  The absence of an established, repeatable, and scalable path to commercialization and prescription of DTx has bottlenecked broader uptake, says one physician leader. Key Takeaways The Centers for Medicare & Medicaid Services has repealed its Medicare Coverage of Innovative Technology final rule. The action leaves multiple unanswered questions for digital therapeutic reimbursement, with payers […]
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early-warning-hospital-billing-errors-portend-bleakness

Early Warning: Hospital Billing Errors Portend Bleakness

Hospitals across the nation are seeing lower profits, and it’s all because of a sudden tsunami of Medicare and Medicaid provider audits. Whether it be by Recovery Audit Contractor (RACs), Medicare Administrative Contractors (MACs), Unified Program Integrity Contractors (UPICs), or otherwise, hospital audits are rampant. Billing errors, especially “supposed bundling,” are causing a high rate […]
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many-final-ipps-rules-are-released

Many Final IPPS Rules Are Released

While much attention has been focused on the release of the IPPS Final Rule, other final rules might have gone unnoticed. The Centers for Medicare & Medicaid Services (CMS) were very busy the first week of August, with the release of final rules for skilled nursing facilities (SNFs), hospices, inpatient rehabilitation facilities (IRFs), and inpatient […]
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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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cms-updates-medicare-part-b-drug-prices

CMS Updates Medicare Part B Drug Prices

Retroactive code pricing updates may require claims lookback. The Centers for Medicare & Medicaid Services (CMS) has posted a retroactive update to the April Average Sales Price (ASP) pricing file for three Medicare Part B drugs. Also now available are the July ASP and Not Otherwise Classified (NOC) pricing files and the ASP NDC HCPCS […]
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2021 MPFS Payment Rates

CMS Recalculates Medicare Physician Fee Schedule Rates for 2021

  CMS has updated Medicare Physician Fee Schedule rates for 2021 after a COVID-19 stimulus package mitigated budget neutrality cuts finalized in a December rule. The Consolidated Appropriations Act, 2021 passed by Congress on Dec. 21, 2020, enacted a 3.75 percent increase in Physician Fee Schedule payments for all providers in 2021 to “support physicians and other professionals in adjusting […]
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2021 Evaluation & Management Code Changes

A Glance at 2021 Evaluation and Management Changes

The evaluation and management (E/M) changes for calendar year 2021 are the result of a collaborative effort between the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS). CMS first addressed the changes in the 2020 Medicare Physician Fee Schedule Final Rule, in which CMS indicated that it planned on adopting […]
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Medicare Reimbursement rate for COVID-19 Testing

CMS Reduces Medicare Reimbursement Rate for Some COVID-19 Tests

The base Medicare reimbursement rate for COVID-19 tests using high throughput technology will decrease to $75 next year unless labs can process results in 2 days or less. CMS will reduce the base Medicare reimbursement rate for COVID-19 tests done by laboratories using high throughput technology, according to a new announcement. The announcement made late last […]
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