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

Medicare covering OTC COVID-19 tests

April 4, 2022 by

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.

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MOM WEBINAR

Learn about changes and updates to telehealth

March 25, 2022 by

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.

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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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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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COMPLIANCE

OIG sounds the warning on improper COVID-19 vaccination billing

May 2, 2021 by

Providers that furnish COVID-19 vaccination and testing services need to look ahead and prepare for the massive federal false billing crackdown that is sure to come if and when the pandemic crisis finally tails off. The latest rumblings from the federal enforcement volcano occurred on April 15 when the OIG issued a relatively rare “Message From HHS-OIG Leadership” (Message) to let it be known that the agencies are hearing reports of false billing and “remain vigilant and committed to holding perpetrators of [COVID-19-related] fraud schemes accountable.” Compliance managers at vaccination facilities are well advised to audit whether their organizations are currently meeting the billing and reimbursement rules the Message summarizes. 6 things to check to ensure proper billing of COVID-19 vaccination The Message specifically reminds providers is being provided by… . . . 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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INCREASING PROFITS

The physician enterprise model: a non-employment alternative

February 16, 2021 by

By John W. McDaniel bio Hospitals are seeking new and innovative ways to affiliate with physicians that differ from tactics used in the 1990s, These new relationships involve a more formal type of relationship with physicians, which might reflect lessons learned through previous less‐than‐satisfactory relationships. Most hospitals have physician integration strategies as a part of their long‐range plans, but because physicians employed by hospitals lose approximately $190,000 per year, hospitals and health systems must explore alternatives to physician affiliation aside from the traditional employment model. Beyond employment Affiliation is sought for various reasons. Large hospitals seek a wider reach into communities, while small and rural hospitals seek help with physician recruitment, which has been troublesome over the past years due to 84% of senior medical residents desiring to practice in… . . . read more.

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