The Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) initiative is a new model for ACOs operating under Medicare. It will be tested under the Centers for…
Providers would do well to think beyond any specific national standard, to more specific details, when considering denial appeals. A member of a message board I follow, and to which…
The changes will become effective in about three months, giving providers time to modify processes. The staff at the Centers for Medicare & Medicaid Services (CMS) have been working overtime…
COVID-19 has spurred innovation and growth, including the trend toward outpatient care at office-based labs. As a result of increased calls to keep patients out of the hospital and safe…
RACmonitor launches an occasional series, “RAC Rants,” with this first post by past president of the Healthcare Business and Management Association (HBMA) Holly Louie. Entries are welcome at editor@medlearnmedia.com. The…
CMS announced it would be reinstating the COVID-19 healthcare worker vaccine mandate to facilities in 25 states and the District of Columbia that are not affected by the preliminary injunction. The states…
CMS says it the goal is to support health equity while focusing on high-quality person-centered care. Increased leverage of telehealth for behavioral care, diabetes prevention and mitigation, and enhanced payment…
Everyone in the industry knows about audits of healthcare providers. But what about the billing companies? Or a data-analytics company? In a complaint filed last week, a New York data-mining…
Medicare intends next year to allow physician assistants (PAs) to begin directly billing for their work and to expand coverage of telehealth services. It also intends to change the approach…
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…
Inpatient hospital stays have become more expensive to the Medicare program. It's a trend that began even before the COVID-19 pandemic. A new report from the Department of Health and…
Phone call codes during the PHE range from 99441 to 99443, and are all based on time. In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services…
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…
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…
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…