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You are here: Home / Archives for topics / Billing and collections
BILLING

Newly proposed Medicare Part B Physician Fee Schedule contemplates Making COVID-19 telehealth changes permanent

July 22, 2021 by

On July 13, 2021, CMS published its proposed physician fee schedule rule for FY 2022. One of the key items is the proposal to make the temporary change allowing Medicare providers to deliver healthcare services via telehealth a permanent part of Medicare Part B. The Proposed Medicare Changes During the public health emergency (PHE), Congress added the home of the beneficiary as a permissible originating site for telehealth services for the purposes of diagnosis, evaluation or treatment of a mental health disorder. In addition to updating the fee schedule, the proposed CY2022 rule would allow certain services added to the Medicare telehealth list to remain on the list until the end of December 2023. This would allow CMS to continue to evaluate whether the temporary expansion of telehealth services adopted… . . . read more.

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BILLING

New federal rule to protect consumers from surprise medical bills

July 13, 2021 by

The Biden-Harris Administration has announced a rule to protect consumers from surprise medical bills. The U.S. Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management, issued “Requirements Related to Surprise Billing; Part I,” an interim final rule that will restrict excessive out of pocket costs to consumers from surprise billing and balance billing. Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. Balance billing, when a provider charges a patient the remainder of what their insurance does not pay, is currently prohibited in both Medicare and Medicaid. This rule will extend similar protections to Americans insured through employer-sponsored and commercial health plans. “No patient should… . . . read more.

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INCREASING PROFITS

Denial management: the missing ingredient in revenue cycle management

July 1, 2021 by

By John McDaniel The blueprint for effective Revenue Cycle Management (RCM) is complex in today’s healthcare environment. When we map out the RCM process, it includes the following steps: Patient scheduling and registration Insurance eligibility and benefit verification Collection of copayments and deductibles at time of service Claims submission Remittance processing Denial management Back‐end patient collections Denial Management Implementing an effective and efficient process for managing claim denials is likely the single most important action a healthcare organization can make to affect its revenue cycle. Denial management is by no means a simple process; in fact, it is often extremely complex. According to the American Academy of Family Physicians, the average claim denial rate across the healthcare industry is 5 to 10 percent, varying between specialties. With the average cost… . . . read more.

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FALSE CLAIMS

Provider pays $214K for violating federal COVID-19 workplace protocols

June 20, 2021 by

In one of the first of what will likely be a flood of enforcement actions, the Texas parent of an Iowa nursing home has agreed to repay $214,200 in federal monies for not following coronavirus safety protocols during an outbreak at the facility from April through July 2020. Among other things, the nursing home didn’t properly screen employees or require them to wear personal protective equipment. According to newspaper reports, three employees exhibiting COVID-19 symptoms and who subsequently tested positive for the virus were allowed to come to work and be near vulnerable residents, 11 of whom died during the outbreak. The False Claims Act connection The relatively small settlement award belies the importance of this case. What the case illustrates is that failure to follow COVID-19 protocols can result… . . . read more.

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GETTING PAID

Getting Medicare reimbursement for telehealth services: The new CONNECT for Health Act

June 9, 2021 by

Like most cliches, the one about the COVID-19 pandemic’s transformation of medicine forever is laden with truth. Telemedicine is Exhibit A. Of course, telemedicine goes back decades. But the pandemic accelerated the breakdown of resistance on the parts of providers, regulators and above all, patients. It was supposed to be just temporary. But to use still one more cliché, now that the toothpaste is out of the tube, it becomes a matter of figuring out how to regulate it effectively. Ironically, but hardly unexpectedly, one of Congress’ first attempts to impose systematic regulation involves recycling a piece of legislation that falabiled to gain support in pre-pandemic times but may make it into law this time. Here’s a quick overview of the so-called CONNECT for Health Act and what medical office… . . . read more.

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REIMBURSEMENT

CMS reweighting 2020 MIPS cost performance category

May 20, 2021 by

The Centers for Medicare & Medicaid Services (CMS) recognizes the impact of the COVID-19 pandemic public health emergency (PHE) on clinicians across the country and continues to offer flexibilities to provide relief where possible. Under § 414.1350(d)(3), the Merit-based Incentive Payment System (MIPS) cost performance category weight is 15% of the final score for the 2020 performance period/2022 MIPS payment year. CMS wants all MIPS eligible clinicians to know it is reweighting the cost performance category from 15% to 0% for the 2020 performance period. The 15% cost performance category weight will be redistributed to other performance categories in accordance with § 414.1380(c)(2)(ii)(D). See the table below for reweighting scenarios. Analysis of the underlying data for the 2020 performance year, in comparison to prior years’ data, shows that the volume… . . . read more.

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TECHNOLOGY

5 tech resources improving medical practice efficiency this year

April 3, 2021 by

By Alison Foster bio There was a notable increase in the adoption of healthcare technology by practices and providers in 2020. This continues in 2021, especially as the COVID-19 pandemic shows no signs of letting up. Many practices are short on both human and financial resources and need to increase efficiency to the maximum. Here are some forms of healthcare technology you can rely on to optimize your practice’s efficiency in 2021. Cloud computing Keeping patient data safe and accessible is critical in healthcare. Traditional methods of storing patient data often have challenging retrieval and sharing processes. Cloud computing solves many of these problems and is fast becoming the go-to choice for many practices. Electronic health records stored on the clouds means that providers and authorized personnel can access patient data… . . . read more.

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CMS

Medicare payment upped for COVID-19 vaccine

April 3, 2021 by

The Centers for Medicare & Medicaid Services (CMS) has increased the Medicare payment amount for administering the COVID-19 vaccine. This new and higher payment rate will support important actions taken by providers that are designed to increase the number of vaccines they can furnish each day, including establishing new or growing existing vaccination sites, conducting patient outreach and education, and hiring additional staff. For COVID-19 vaccines administered on or after March 15, the national average payment rate for physicians, hospitals, pharmacies and many other immunizers will be $40 to administer each dose of a COVID-19 vaccine. This represents an increase from approximately $28 to $40 for the administration of single-dose vaccines, and an increase from approximately $45 to $80 for the administration of COVID-19 vaccines requiring two doses. The exact payment… . . . read more.

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CODING

New devices, technology dominate 2021 CPT code changes

March 28, 2021 by

By Lisa Eramo bio There is a whole slew of new and revised CPT codes—329 changes to be exact—effective since Jan. 1. This includes 206 new codes, 54 deletions, and 69 revisions. Interestingly, the majority of changes pertaining to new technology and devices, giving medical practices the opportunity to provide high-quality patient care while also receiving reimbursement. This article summarizes three notable changes. Retinal imaging using augmented intelligence The American Medical Association (AMA) added CPT code 92229 for retinal imaging with automated point-of-care analysis and report (unilateral or bilateral). Per the AMA, this technology better supports patient screening for diabetic retinopathy, and it increases the early detection and incorporation of findings into diabetes care. What’s interesting about this procedure is that it relies on augmented intelligence (AI) technology, says Kimberly Huey,… . . . read more.

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MIPS & QPP

Two data deadlines approaching this month

March 19, 2021 by

Two deadlines are coming up for physician practices: The Quality Payment Program Doctors and Clinicians Preview Period will close on March 25. And the data submission period for Merit-based Incentive Payment System eligible clinicians who participated in the 2020 performance year of the Quality Payment Program (QPP) ends March 31. Preview your performance information CMS opened the Doctors and Clinicians Preview Period on Jan. 25, 2021 at 10 a.m. The Preview Period provides an opportunity for doctors and clinicians to review their 2019 Quality Payment Program (QPP) performance information before it is publicly reported on clinician and group profile pages on Medicare Care Compare and in the Provider Data Catalog (PDC). You can access the secured Preview through the QPP website. Here’s where to find guidance on previewing your information: Pre-recorded Presentation: Preview Period: Performance Information for Doctors and… . . . read more.

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