"Fees" & "TeleMedicine" Articles
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April 12th, 2021
How to Combat COVID-Related Risk Adjustment Losses with the Medicare Annual Wellness Exam
| Published April 12th, 2021
Identifying new ways to encourage Medicare beneficiaries to schedule and attend their Annual Wellness Exam (AWE) can be difficult, but the Open Enrollment period is a prime time for every payer to identify new beneficiaries and provide a reminder to both new and existing patients that this preventive service does ...
February 11th, 2021
2021 Medicare Physician Fee Schedule Updates - Do You Really Need to Worry?
| Published February 11th, 2021
January 11th, 2021
Good and Bad News Regarding the 2021 Medicare Physician Fee Schedule
| Published January 11th, 2021
When the proposed Medicare Physician Fee Schedule came out last year, it really got everyone worried. In a time where we are all facing issues related to COVID, this seemed like a really big problem. Professional organizations lobbied and everyone tried to stop the proposed changes, and the 10.2% decrease didn’t happen, but other changes will still be taking place. So how bad is it really and how will it affect your organization?
December 8th, 2020
Final Rule on Communications Technology and 2021 Physicians Fee Schedule
| Published December 8th, 2020
To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...
October 20th, 2020
CMS Expands Telehealth Again
| Published October 20th, 2020
On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services.
September 23rd, 2020
My Location and CBSA is Missing!
| Published September 23rd, 2020
We often get questions on missing Core Based Statistical Areas, known as CBSAs. CBSAs are used for pricing and other factors according to the geographical location. If you do not see your CBSA, it is important to note they are not missing - it may not have an assignment, according to ...
August 7th, 2020
Impact of 2021 Proposed Medicare Fee Schedule on Chiropractic Offices
| Published August 7th, 2020
On August 3, 2020, the proposed Medicare Physician Fee Schedule for 2021 was released. This 1,355 page document includes some sweeping changes to the Medicare program. There are a few items in particular which should be noted by chiropractic offices.
July 9th, 2020
Payment Adjustment Rules for Multiple Procedures and CCI Edits
| Published July 9th, 2020
Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ...
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
| Published July 1st, 2020
June 15th, 2020
Outpatient Facility Pricing
| Published June 15th, 2020
Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ...
June 3rd, 2020
Watch for Payer Telehealth Coverage Changes
| Published June 3rd, 2020
As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.
May 13th, 2020
Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?
| Published May 13th, 2020
On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states:
“Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...
May 4th, 2020
Additional Telehealth Changes Announced by CMS
| Published May 4th, 2020
On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.
April 20th, 2020
Dismal OIG Report on Telemedicine
| Published April 20th, 2020
Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.
April 13th, 2020
COVID-19 Chiropractic Resources
| Published April 13th, 2020
COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes.
April 7th, 2020
More Telehealth Changes Announced by CMS Chiropractic Offices Should Know About
| Published April 7th, 2020
On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). The announcement included far more information than is presented in this article which only summarizes the changes to telehealth. In fact, it does change a little of the information included in our March 31st webinar.
April 2nd, 2020
More Telehealth Changes Announced by CMS
| Published April 2nd, 2020
On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information
March 30th, 2020
Spotlight: UCR Fees are Available on DRGs- Check it Out!
| Published March 30th, 2020
Check out the information page on any DRG! Look up DRGs by going to the list of DRG codes found under the Codes tab at the top of the page, or simply type in the desired DRG by using the search bar on the homepage.
When using the search bar, be sure you have the ...
March 25th, 2020
COVID-19: Cybercrime, Telehealth, and Coding
| Published March 25th, 2020
Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along.
We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...
January 14th, 2020
Billing for Telemedicine in Chiropractic
| Published January 14th, 2020
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
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