Medical Billing and Coding Compliance for Telehealth
By Ghazal Irfan, RHIA, and Monica Watson The COVID-19 public health emergency (PHE) generated a need for expanded telehealth regulatory requirements resulting in exponential growth in telehealth services. While initially used for convenience, telehealth quickly became a necessity for safety and continuity of care. In the days since the PHE...
My career has been shaped by two critical experiences: burning out as a physician and witnessing the poor quality of clinical data as an analytics consultant for large payers. I realized that these problems are merely two sides of the same coin, and I am writing this article to...
Medical Reviews
Make sure your physician practice is prepared for renewed scrutiny of Medicare claims. Medicare Part B post-payment, service-specific medical reviews resumed Aug. 17, 2020, after a brief hiatus due to the COVID-19 public health emergency. Prepare for time-sensitive Additional Documentation Request (ADR) letters by knowing what services Medicare Administrative Contractors...
Easing pain caused by injury, disease, chronic condition, addiction, or any combination of these is a noble and rewarding pursuit that involves skill, determination, and an eye for patients’ reactions and body language. Those qualities and instincts are complemented when intelligent, specialty-specific, hands-free automation is in your corner for: ensuring...
COVID-19 Vaccine Admin Fee
New payment rates are effective immediately. The Medicare payment amount for administering the COVID-19 vaccine is increased, effective March 15, 2021. The national average for physicians, hospitals, pharmacies, and other immunizers to administer the COVID-19 vaccine is now approximately $12 more for the administration of single-dose vaccines and $35 more for...
Cost Sharing
Are you working off the latest list of codes applicable for modifier CS? During the public health emergency (PHE) for COVID-19, patients’ Medicare Part B cost sharing (coinsurance and deductible) is waived for certain healthcare services. The Centers for Medicare & Medicaid Services (CMS) maintains a list of codes to...
hospital admissions
By Jacqueline LaPointe February 25, 2021 - Hospitals are facing another setback as non-coronavirus hospital admissions drop yet again after months of recovery, according to a recent analysis. Hospital admissions for reasons other than COVID-19 dropped to approximately 80 percent of predicted levels nationally by the week ending Dec. 5, 2020, Epic...
Hospitals Increasingly Billing Inpatient Stays at Highest Severity
A new report from the HHS Office of the Inspector General (OIG) has shown that hospitals have increasingly billed inpatient stays at the highest severity level, causing concern about Medicare spending. The report analyzed paid Medicare Part A claims for inpatient stays from fiscal years 2014 through 2019. The claims...
1. The COVID-19 pandemic will likely last for 18 to 24 months until herd immunity is developed, according to a new report from the University of Minnesota's Center for Infectious Disease Research and Policy. Infectious disease experts say the pandemic cannot...
How to code Medicare Part B claims for reimbursement. These past few months have been a whirlwind for everyone, but it’s fair to say medical coders have been hit with a category 5 hurricane. New codes and revised guidelines have been whirring about, making our heads spin. And now we...