Tagged with ICD-10 Diagnosis Coding

CMS Releases 2021 MA and Part D Advance Notice Part II

On February 5, CMS released Part II of the Calendar Year (CY) 2021 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies. In the CY 2021 Advance Notice, the agency is proposing updates and changes to the methodologies used to pay MA plans, Programs of All-Inclusive Care for the Elderly (PACE) organizations, and Part D sponsors.

FDA Issues Gene Therapy Guidances

On January 28, the FDA issued six final guidances on gene therapy manufacturing and clinical development of products, as well as a draft guidance, describing the agency’s proposed approach to determining sameness of gene therapy products for orphan drug designation and exclusivity purposes.

CMS Publishes FY 2022 SNF APU Overview Table

CMS, on January 30, published the Fiscal Year (FY) 2022 Skilled Nursing Facility (SNF) Annual Payment Update (APU) table, indicating the data elements the agency will use for FY 2022 SNF Quality Reporting Program APU determinations.

2021 Proposed Changes for Evaluation and Management Services

By Marie Franklin, MBA, National  Director of Coding, Education, and Audit The proposed new rules for 2021 will focus on medical decision-making or time as the determining factor when selecting the appropriate level for service rendered for all physicians for evaluation and management. Currently, Medicare has not made Medical Decision Making (MDM) as one of…

ACR Seeks Urgent Action Opposing Cuts to Radiology

The American College of Radiology (ACR) is seeking help in its efforts to urge Congress to stop CMS from implementing proposed changes to the Evaluation and Management (E/M) Codes that could result in severe cuts to radiology.

Humana Releases Latest Claims Payment Policy Updates

Humana has published its latest medical claims payment policy updates, including its reimbursement policy for ambulance transportation, requirements for billing and documentation of observation services, as well as a new policy for obstetric billing, including antepartum, delivery and postpartum care.

Executive Order Issued to Protect Traditional Medicare and MA Plans

The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.

Data Mining Anesthesia Billing Data for Improved Practice Performance

By Joe Laden, Vice President of Client Management All billing companies and in-house billing operations provide a package of standard reports.   They are generally financial reports designed to report cash flow and illustrate the performance of the billing entity However, data collected for billing can provide a wealth of information for the practice beyond the…

Improper Payment for Intensity-Modulated Radiation Therapy Planning Services

In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity Modulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.

Anthem Connecticut Introduces New Prior Auth Pass Program

Anthem is introducing a new program to reduce the administrative burden associated with current prior authorization (PA) processes for providers who are contracted with Anthem in Connecticut. The Prior Auth Pass Program allows providers who meet program requirements to waive prior authorization for select outpatient medical procedures that generally have high rates of PA requests and approvals.

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