Articles related to CODING & REIMBURSEMENT

The imminent CMS coding changes, leading to massive pay cuts, threaten to significantly reduce the availability of DIEP flap breast reconstruction, a procedure renowned for its superior patient outcomes. The potential repercussions, such as increased health disparities and a loss of specialized surgical skills, underscore the urgent need for policy reconsideration.

A new comprehensive study brings to light the considerable cost disparities between FLACS and PCS, urging opthalmologists to reconsider their preferred surgical procedures for cataract treatment.

Navigate the rapidly changing landscape of patient communication, as we explore the ins and outs of charging for MyChart messages. The COVID-19 pandemic has swiftly transformed the dynamics of healthcare communication. Consequently, healthcare providers increasingly rely on telehealth visits and digital communication tools to connect with patients. A significant offshoot of this shift is the growing trend of charging for MyChart messages. Healthcare systems have begun charging for the time providers spend responding to messages. Some hospitals have even expressed plans to bill up to $50 for MyChart messages. This new approach was permitted through changes to the 2020 Current Procedural Terminology (CPT) codes. The revised codes introduced three new time-based categories, thereby allowing providers to bill for time spent addressing patient-initiated messages over a week. Despite these changes, not all services come with a price tag. As per the Cleveland Clinic, any work taking under five minutes or any service that leads to an in-person consultation will not be charged. Furthermore, no fees apply to prescription refill requests, appointment requests, and follow-up care related to a surgery performed within the last 90 days. However, specific services can be billed. For instance, messages necessitating a clinical assessment, ordering a test […]

CMS released its new, updated, and deleted codes specific to Medicare payers at the end of 2022. The document also highlights payment information that will impact practices providing care to Medicare beneficiaries in 2023.

Oncologists were mentioned in two important specialist areas in CMS’ examination of inappropriate payments made to Part B providers, with the dismal outcomes as follows: Four hundred (400) claims for oncology/hematology were examined; of these, 60.9% lacked sufficient supporting paperwork, 31.9% had inaccurate coding, and the remaining cases had neither, along with no other issues. Given these findings, CMS projects $146 million in erroneous payments. In medical oncology, 147 claims were analyzed; 54.5% had no documentation and 37.7% had inaccurate coding, with the balance (7.9%) having insufficient documentation. According to CMS data, the projected overpayments for this claim sample are $12.9 million.

The agency stated that the JZ modifier (zero drug amount discarded/not administered to any patient) “will be required for all drugs separately payable under Part B that are designated as a single-dose container on the FDA-approved label or package insert for which there are no discarded amounts” in the 2023 Medicare Physician Fee Schedule (MPFS), published Nov. 18, 2022. All suppliers and providers who purchase and bill Medicare Part B separately payment medications (single dose container/package) are subject to the JZ modifier. The modifier is eligible for billing as of January 1, and CMS has given providers until July 1 to adopt it.