Fees Articles and Resources

Resources

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Medicare Updates -- SNF, Neurostimulators, Ambulance Fee Schedule and more (2022-10-20)

by  CMS - MLNConnects

Skilled Nursing Facility Provider Preview Reports: Review by November 14 - Help Your Patients Make Informed Health Care Decisions - Ambulance Fee Schedule: CY 2023 Ambulance Inflation Factor & Productivity Adjustment - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes...

Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.

CMS Started to Enforce Applicable Price Transparency Requirements

by  Amanda Ballif

Beginning July 1, 2022, CMS started to enforce applicable price transparency requirements because of the Trump Administration's historic price transparency requirement in 2019 to increase competition and lower healthcare costs for all Americans.

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule

by  Amanda Ballif

The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.

Interpreting the VA's UCR Pricing

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Representing the methodologies used in the VA's pricing determinations is better understood coming directly from the source or an attorney who is familiar with the laws.  Our responsibility is to educate you with information directly from the source, where you can find your answers or contact them directly. We are happy to ...

UCR Anesthesia Fee Calculations and Base Units - Now Available!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

As per customer request, Find-A-Code now offers UCR Anesthesia Fee Calculations along with CMS and ASA. The anesthesia fee calculations can be found under the Fees section of the code and under the Anesthesia Fee Information.   Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units). NOTE: Always ...

Final Rule on Communications Technology and 2021 Physicians Fee Schedule

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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. ...

My Location and CBSA is Missing!

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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 ...

Payment Adjustment Rules for Multiple Procedures and CCI Edits

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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 ...

Understanding UCR Inpatient Fees used on DRGs

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Outpatient Facility Pricing

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

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 ...

Spotlight: UCR Fees are Available on DRGs- Check it Out!

by  Brittney Murdock, QCC CMCS CPC

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 ...

Preview the PDGM Calculator (HIPPS calculator) for Home Health Today

by  Wyn Staheli, Director of Content - innoviHealth

Find-A-Code's Patient-Driven Groupings Model (PDGM) home health payment calculator (HIPPS Calculator) simplifies payment calculations. See https://www.findacode.com/tools/home-health/ .

New Medicare Home Health Care Payment Grouper — Are You Ready?

by  Wyn Staheli, Director of Content - innoviHealth

In 2020, Medicare will begin using a new Patient-Driven Groupings Model (PDGM) for calculating Medicare payment for home health care services. This is probably the biggest change to affect home health care since 2000.

VA: How UCR Charges are Determined

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...

And Then There Were Fees...

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...

VA- Reasonable Charges Rules, Notices, & Federal Register

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

So How Do I Get Paid for This? APC, OPPS, IPPS, DRG?

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

You know how to find a procedure code and you may even know how to do the procedure, but where does the reimbursement come from?  It seems to be a mystery to many of us, so let's clear up some common confusion and review some of the main reimbursement systems.  One of the ...

Spinal Cord Stimulator Used for Chronic Pain

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Chronic pain is a condition that can be diagnosed on its own or diagnosed as a part of another condition. When coding chronic pain, there is no time frame defining when pain becomes chronic pain; the provider’s documentation should be used to guide the use of these codes. ICD-10-CM Diagnosis Codes ...

No Good Deed Goes Unpunished

by  Ray Foxworth, DC FICC MCS-P

You simply need to read the headlines, posts, and tweets, about providers across the healthcare profession being audited, fined, and some even convicted, to see that the costs of non-compliance are real. We tell ourselves, “It won’t happen to me.” The reality is that it easily could. Your license is your livelihood.
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Coding 2022 Care Management Services 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

What do Chiropractors Need to do to Comply with the No Surprises Act? 

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Pro Fee overview with UCR Fees.

by  Alan Crop, VP Sales - innoviHealth

What is RBRVS and How Can It Benefit Your Organization 

by  Find-A-Code™

What is RBRVS and How Can It Benefit Your Organization

The Importance of Gathering Organizing and Using Fee Schedules 

by  Find-A-Code™

The Importance of Gathering Organizing and Using Fee Schedules

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