New math for prolonged hospital visits could equal revenue surge for practices

Why This Topic Matters

The correction may change whether certain hospital visit claims qualify for prolonged service reporting under Medicare, which can affect reimbursement and claim rebilling workflows. Practices that bill time-based inpatient and observation E/M services need to understand the update to avoid missing potential payment and to align Medicare claims with current guidance.

Article Sections

1. Coding

   Introduces the Medicare update and frames its impact on inpatient and observation E/M claims billed by time. It also points readers to related threshold guidance and claim review considerations.

2. Stick to the new G codes with the new times

   Discusses the updated prolonged service timing framework and the need to track the relevant code sets for Medicare and other payers. It emphasizes that different payer policies may apply and that staff should stay current with the revised thresholds.