Articles related to CODING & REIMBURSEMENT

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.

For some of the most often applied treatments for meibomian gland dysfunction (MGD), such as imaging, exfoliation therapy, heat therapy, strong pulsed light therapy, and meibomian probing, Myranda Partin, OD, offers advice, coding, and reimbursement information.

With regard to his panel, “DSM-5 Text Revision (DSM-5-TR): What’s New and What’s Different,” which was presented at Psych Congress Elevate 2022, Michael B. First, MD, professor of clinical psychiatry at Columbia University in New York City, and editor and co-chair of the DSM-5-TR, responds to questions in this Q&A. The updated text’s main revisions to the “Introduction” and “Use” sections are discussed by Dr. First, who also explains the new diagnoses it now includes and provides his thoughts on how the enhanced text will help psychiatrists in their daily work.

The new codes, which became effective in January 2020, replaced existing EEG Monitoring codes used for limited electrode set (95950), daily video-EEG (95951), ambulatory EEG (95953), and daily EEG without video (95956). Have you reviewed the new codes and figured it all out?