Tag: Medical Billing Services

CMS IPPS Rule

IPPS Final Rules update for Medicare payments for 2023

CMS has published the Fiscal Year 2023 (Oct 1, 2022) final rules for Medicare payments. The major rule is, of course, the inpatient hospital prospective payment system (IPPS) and long-term care hospital (LTCH) PPS rule. The final rule, as reported by Stanley Nachimson, contains several payment and quality program changes that go into effect Oct […]
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CMS Announces New Appeal Rights

Appeal rights appear much narrower than many expected. Earlier this year, a federal appeals court issued an opinion on Barrows v. Becerra, a long-running class action lawsuit. Filed by a group of Medicare beneficiaries, the suit alleged they had to pay out of pocket for skilled nursing care—despite being hospitalized for over three days—because their […]
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CPT Code 95165 Conundrums

Three tips are all you need to correctly bill allergen immunotherapy, single or multiple antigens. Allergy services, such as those reported with CPT® 95165 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy, single or multiple antigens (specify number of doses), remain on the radar of third-party payer investigation units […]
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Keep an eye on Ophthalmology Billing

Learn the nuances of billing these ophthalmology services and reduce your compliance risk. When I first started working in ophthalmology, I worried I would become bored: I mean, after all, it’s just two little eyes, right? I quickly learned how complicated ophthalmology can be and that there are many nuances and layers to coding and […]
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Can you bill E/M from the same appointment?

Despite myths to the contrary, physicians are not prohibited from coding and billing for both preventive and problem-focused evaluation and management (E/M) services when they are performed during the same appointment. Motivated by a desire to avoid audits, many physicians tend to undercode for the work they perform. Others, however, are just unaware that the idea that […]
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Updates on End-Stage Renal Disease Prospective Payment copy

Updates on End-Stage Renal Disease Prospective Payment

CMS issued a proposed rule to update payment rates and policies under the End-Stage Renal Disease Prospective Payment System for renal dialysis services furnished to Medicare beneficiaries on or after Jan. 1, 2023. Here are four takeaways from the proposed rule: Under the proposed rule, Medicare expects to pay $8.2 billion to approximately 7,800 facilities […]
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mgma requests updates to independent dispute resolution portal | AllZone Management Services Inc.

MGMA Requests Updates to Independent Dispute Resolution Portal

The organization recommended CMS update the independent dispute resolution portal to improve communication between disputing parties and adjust the form field requirements. The Medical Group Management Association (MGMA) has asked CMS to update the federal independent dispute resolution (IDR) portal to streamline the arbitration process for determining an out-of-network payment rate for a surprise medical […]
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