On January 1, 2022, key provisions of the No Surprises Act (NSA) went into effect. At its core, the No Surprises Act seeks to protect patients from surprise bills generated by out-of-network emergency or air ambulance service providers, or other out-of-network (OON) services provided at in-network facilities. Here’s where we are one month in. READ MORE
A small provision of the 2021 Consolidated Appropriations Act paves the way for Medicare patients to eventually pay no coinsurance for colorectal cancer screening tests when they become diagnostic. CMS finalized how that guideline will be enacted in the 2022 Medicare Physician Fee Schedule. READ MORE
When claims are denied by Medicare, providers have the right to appeal the decision. In fact, providers can appeal a decision up to five times–all the way to a judicial review in U.S. District Court–if they disagree with the rulings. But not all denials merit an appeal, and when they do, each level of appeal is different and must be sent to a different contractor. Wondering if an appeal is your next step? Here’s how to know when you should appeal and at what level and where to send it. READ MORE
Emergency departments serve on the frontline of the fight against drug overdoses and opioid use disorder. While there have been several barriers to providing and billing for medication assisted treatment in the ED, many of those barriers have been reduced or eliminated. When emergency physicians do administer and/or prescribe MAT, here’s what they should document and code for their services. READ MORE
The Medicare Place of Service Workgroup recently revised the telehealth place of service codes to reflect the need for greater specificity in the industry. While Medicare itself has not identified a use for the update within their own billing guidelines, they’ve made changes because “the healthcare industry has a greater need for specificity than Medicare” and “this eases coordination of benefits and gives other payers the setting information they need.” READ MORE
As we prepare for 2022, the Centers for Medicare and Medicaid Services (CMS) has released a variety of information healthcare providers need to know about billing Medicare in the new year. We’ve created a short list of the top seven things providers should know. READ MORE
In the final rule of the 2022 Medicare Physician Fee Schedule, CMS made several changes to their longstanding policies for split (or shared) evaluation and management (E/M) visits and Critical Care Services. Here’s an overview of the new policies, along with some documentation and coding suggestions.
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The Centers for Medicare and Medicaid Services is once again applying an Automatic Extreme and Uncontrollable Circumstances Policy for the 2021 MIPS Performance Year in response to the COVID-19 Public Health Emergency. The policy affects providers differently depending on how they report MIPS. READ MORE
The Centers for Medicare and Medicaid Services recently published the final rule of the Medicare Physician Fee Schedule for 2022. In addition to changing the payment rates for 2022, CMS also finalized changes to several payment policies. We’ve highlighted a few of the biggest for anesthesiologists below. READ MORE
The Centers for Medicare and Medicaid Services recently published the final rule of the Medicare Physician Fee Schedule for 2022. In addition to changing the payment rates for 2022, CMS also finalized changes to several payment policies. We’ve highlighted a few of the biggest. READ MORE
