CMS has raised the Medicare payment rate for certain COVID-19 antibody infusions and included a new payment policy for at-home administration, which will have a higher payment rate compared to…
Many nursing home COVID-19 patients would have benefited from daily, reimbursed-for physician visits in their skilled nursing facilities, but they were not entitled to them. With an epic crisis still…
Proposed rules offer insight into the Administration’s priorities. The Centers for Medicare & Medicaid Services (CMS) has issued its first proposed payment rules under the Biden Administration. While these rules…
Estimated savings are $75 million over a decade. Federal officials recently announced a series of changes to the Medicare Advantage (MA) and Part D prescription drug programs they hope will…
CMS just issued a correction to its guidance on 2021 Medicare rules for remote physiologic monitoring (RPM) services. The correction is effective January 1, 2021 and revises the preamble commentary in the…
CMS has codified how it defines “reasonable and necessary” coverage for items and services that may be covered under Medicare Parts A and B in a new final rule. The…
I. Introduction Zone Program Integrity Contractors (“ZPICs”) are charged with the responsibility of investigating alleged instances of fraud, waste, or abuse by health care providers. They are authorized to conduct…
Are you prepared for the sweeping changes made to the “traditional” 1995 and 1997 evaluation and management (E/M) guidelines for office and outpatient visit codes you have been accustomed to…
The Centers for Medicare and Medicaid Services (CMS) released 21 new ICD-10-PCS codes that apply to the vaccination or treatment of COVID-19. These codes are effective January 1, 2021. The…
Just a day after the FDA approved the emergency use of a new COVID-19 antibody drug, CMS updated Medicare payment and billing policies to ensure providers have access to the…
The Centers of Medicare & Medicaid Services (CMS) has approved a new, specific diagnosis code for Friedreich’s ataxia (FA) to be used by clinicians in medical records and examined by…
Yesterday, CMS unveiled the highly anticipated Inpatient Prospective Payment System (IPPS) final rule for the 2021 fiscal year (FY). Chief among the rule’s updated policies is a 2.9 percent increase…
COVID-19 data reporting will no longer be voluntary for hospitals participating in Medicare and Medicaid programs, according to a new interim final rule from CMS. The rule released yesterday updated…
Medicare contractors were inconsistent in how they reviewed overpayments during the appeals process, says the Office of Inspector General in a new report. Although MACs and QICs generally reviewed appealed…
Centers for Medicare & Medicaid Services are proposing to eliminate the inpatient-only list over the next three years. Medicare’s often-misunderstood inpatient-only list may soon be departing, as the Centers for…
The Centers for Medicare & Medicaid Services (CMS) in the past week has proposed Medicare payment rules for outpatient services and physicians for 2021 and finalized payment rules for inpatient…