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CODING & BILLING

CPT update for COVID-19 boosters adapted to omicron

The American Medical Association has announced an update to Current Procedural Terminology (CPT)®, that includes eight new codes for the bivalent COVID-19 vaccine booster doses from Moderna and Pfizer-BioNTech. The updated boosters are adapted for the BA.4 and BA.5 Omicron subvariants and the original coronavirus strain in a single dose. Four of the eight CPT codes (91312, 91313, 0124A and 0134A) are effective for use immediately as the U.S. Food and Drug Administration (FDA) has authorized Moderna’s new COVID-19 booster in individuals 18 years of age and older and Pfizer-BioNTech’s new COVID-19 booster in individuals 12 years of age and older. Four CPT codes (91314, 91315, 0144A and 0154A) will be effective for use on the condition that the FDA authorizes Moderna’s new COVID-19 booster in individuals 6 years through… . . . read more.

BILLING & CODING

Telehealth policy to change after the COVID-19 public health emergency

The COVID-19 public health emergency has been extended to Oct. 13. Of particular interest to medical practices is the continuation of telehealth flexibilities, which will expire at the end of the public health emergency. US Department of Health and Human Services Secretary Xavier Becerra officially renewed the declaration in mid-August. The emergency declaration has been in place since January 2020, and the latest renewal came as the Omicron offshoot BA.5, the most contagious variant yet, continues to stake its claim in the US. Daily case rates, though vastly undercounted, are the highest they’ve been in months, as are COVID-19 hospitalizations and deaths. Data published in August by the US Centers for Disease Control and Prevention shows that more than half of the country’s population lives in a county with a… . . . read more.

BILLING & COLLECTIONS

Medicare covering OTC COVID-19 tests

Starting this week and through the end of the COVID-19 public health emergency (PHE), Medicare covers and pays for over-the-counter (OTC) COVID-19 tests at no cost to people with Medicare Part B, including those with Medicare Advantage (MA) plans. In addition to helping prevent the spread of COVID-19, the goal is to find out if Medicare payment for OTC COVID-19 tests will improve access to testing and result in Medicare savings or other program improvements. What’s covered Eligible providers or suppliers can distribute U.S. FDA-approved, authorized, or cleared OTC COVID-19 tests to patients enrolled in Part B, including those enrolled in MA plans. Patients who only have Medicare Part A can get free OTC COVID-19 tests through other government-led programs, like covidtests.gov, which operates through the United States Postal Service (USPS). Or,… . . . read more.

MOM WEBINAR

Learn about changes and updates to telehealth

There’s a lot you need to know about telehealth. That’s why Medical Office Manager is offering a webinar, Telehealth—What Managers Need to Know, on April 6. It’s free to Medical Office Manager members. Presenter Jen Bell of Karen Zupko and Associates will give you the tools and knowledge you need to comply with new telehealth regulations. Meanwhile here is Jen’s update on telehealth changes to early 2022. POS 10 Telehealth Provided in Patient’s Home Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. Home may be defined to include temporary lodging (hotels, homeless shelters) and patient travels of short distance from the exact… . . . read more.

CMS

Medicare payment upped for COVID-19 vaccine

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.

CODING

New devices, technology dominate 2021 CPT code changes

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.

CODING

Impact of reimbursement and compliance to WRVU-based compensation

By John McDaniel bio All physician contracts including any form of WRVU based compensation may need to be reviewed and probably amended because of the increase in WRVUʹs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. This has been necessitated by CMS whereby the final decision involved eliminating CPT Code 99201 and leaving CPT Code 99211 unchanged. The changes for CPT Codes 99202‐99205 and 99212‐99215 have resulted in increased physician/provider reimbursement since the WRVUs for these codes have been significantly changed. Indeed, this increase in the WRVU component will certainly affect physician compensation. While the major commercial payers have not yet announced their intention to utilize the 2021 E&M codes, those decisions will greatly impact both provider reimbursement and WRVU utilization. It should be noted… . . . read more.

CODING

Impact of 2021 evaluation and management coding changes to WRVU based physician compensation

By John McDaniel bio As you may know, all physician contracts which include any form of WRVU based compensation will need to be reviewed and probably amended due to the increase in WRVUs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. We recently conducted an assessment for one of our hospital clients which showed the ʺunintended consequencesʺ of increased compensation to the physicians/providers and the resultant impact to fair market value standards. This has been necessitated by CMS whereby the final decision involved eliminating CPT Code 99201 and leaving CPT Code 99211 unchanged. The changes for CPT Codes 99202‐99205 and 99212‐99215 have resulted in increased reimbursement since the WRVUʹs for these codes have increased. Indeed, the increase in the WRVU component will certainly affect physician compensation… . . . read more.

CODING

Here’s how to represent telehealth encounters in QRDA I Format for eCQMs

The Centers for Medicare & Medicaid Services (CMS) has posted additional guidance for using the Quality Reporting Document Architecture I (QRDA I) format to represent telehealth encounters for the Eligible Professional and Eligible Clinician electronic clinical quality measures (eCQMs) used in CMS quality reporting programs for the 2020 and 2021 performance periods. There is no change to the original guidance provided by CMS in July 2020. Representing Telehealth Encounters in QRDA I format by using the Qualifier attribute: To represent “telehealth-eligible” Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for eCQMs in QRDA I, submitters should use the optional qualifier attribute of the encounter code element to send the telehealth modifier code in addition to the primary “telehealth-eligible” CPT or HCPCS encounter code from the eCQM-specified value sets. The qualifier attribute name is… . . . read more.

CODING ALERT

Physicians should consider these overlooked codes

By Lisa Eramo bio It’s a common complaint heard among primary care physicians: Evaluation and management (E/M) codes don’t adequately capture the time, skill, and resources necessary to plan and coordinate care for patients with complex medical needs. Although new, streamlined E/M guidelines for 2021 may help, several existing remedies can enable physicians to capture additional revenue for the services they provide. More specifically, the U.S. Government Accountability Office (GAO) has published a list of 58 CPT codes that fall under the category of “longitudinal comprehensive care planning” (LCCP) for Medicare beneficiaries diagnosed with a serious or life-threatening illness. These codes include elements of shared decision-making through interdisciplinary care as well as development of a care plan to address the following: Progression of the disease and treatment options Beneficiary’s goals,… . . . read more.


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