Tag: medicare payment

the-challenges-of-billing-observation-correctly

The Challenges of Billing Observation Correctly

Observation, outpatient outlier payments, and the Inpatient-only List: Getting it right is not always easy. On this week’s Monitor Mondays we had a robust discussion about Condition Code 44. And on June 9, I will be presenting a webinar on the nebulous concept of “outpatient” service in a bed. Both of these have one thing […]
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hhs-distributes-1.75b-in-phase-4-covid-19-provider-relief-funds

HHS Distributes $1.75B in Phase 4 COVID-19 Provider Relief Funds

  Around 3,600 healthcare providers that have experienced pandemic-related revenue losses and expenses will receive payments through this round of Phase 4 COVID-19 Provider Relief Funds. Through the Health Resources and Services Administration (HRSA), HHS has released the fifth round of Phase 4 COVID-19 Provider Relief Funds, which includes $1.75 billion for healthcare providers that […]
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cms-issues-2023-ipf-pps-proposed-rule

CMS Issues 2023 IPF PPS Proposed Rule

  Provisions include topsy-turvy payment adjustments across the country. A proposed rule outlines payments, wages, and policies in fiscal year (FY) 2023 for inpatient psychiatric facilities paid under the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). The Centers for Medicare & Medicaid Services (CMS) issued the proposed rule March 31 and is accepting public […]
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physician-fee-schedule-final-rule-cy-2022

Physician Fee Schedule Final Rule for Calendar Year 2022 – CMS Cuts Rates and Extends Telehealth

On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) issued its Calendar Year (CY) 2022 Physician Fee Schedule (“PFS”) Final Rule. In this post, we sample some key highlights from the Final Rule. For more detail, take a look at our previous post, in which we highlight the PFS’s changes to the […]
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providers-share-benefits-of-medicare-advantage-during-covid-19

Providers Share Benefits of Medicare Advantage During COVID-19

Providers’ experiences with Medicare Advantage plans’ capitated payment models, supplemental benefits, and overall influence gave them recommendations for CMS. There has been a lot of valuable conversation around the benefits that Medicare Advantage health plans can offer to consumers, but now providers have offered their perspectives on this form of health insurance in Better Medicare […]
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biden-administration-drug-plan-includes-value-based-payment-ideas-for-medicare

The Biden Administration Drug Plan Includes Value-Based Payment Ideas for Medicare

The administration said it would make the results of its drug price negotiations with manufacturers, as well as its approach to value-based care models, open to a variety of payers. The Biden administration Thursday released its plan to reduce prescription drug prices, which would include the use of models to test value-based payments in Medicare […]
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CMS-rules-for-payer-provider

CMS To Repeal Public Disclosure Of Payer-Provider Negotiated Rates

The Centers for Medicare & Medicare Services on Tuesday unveiled a sweeping proposed rule that would nullify the mandated public disclosure of negotiated rates between payers and providers and increase by 2.8% Medicare’s inpatient prospective payment in fiscal year 2022. “The rule’s provisions seek to sustain hospital readiness to respond to future public health threats, […]
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revenue-code-for-covide-19-monoclonal-antibody-fusion

Determining Revenue Code for COVID-19 Monoclonal Antibody Infusion

The COVID-19 monoclonal antibodies are being paid under the vaccine benefit. Q: What revenue code should be attached to HCPCS codes M0239 (intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring) and M0243 (intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring)? We set it up as revenue code 260 but are getting […]
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