Tagged with Emergency Medicine Billing
Telehealth Benefits Temporarily Expanded
The White House has announced that beginning on March 6, Medicare administered by CMS will temporarily pay clinicians to providing virtual visits and other telehealth services to beneficiaries.
CMS Issues Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
CMS has issued a fact sheet detailing existing federal rules governing health coverage provided through the individual and small group insurance markets that apply to the diagnosis and treatment of COVID-19.
CPT® Releases New Coronavirus (COVID-19) Code & Description for Testing
A new CPT® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems and laboratories in the United States. The new code became effective March 13, 2020 for use as the industry standard for reporting of novel coronavirus tests across the nation’s health care system.
CDC Releases ICD-10 Official Coding Guidelines Related to COVID-19
The Centers for Disease Control (CDC) has released official diagnosis and coding guidance for health care encounters and deaths related to the 2019 novel coronavirus (COVID-19).
Florida First State to Receive Federal Approval for 1135 Medicaid Waiver to Address COVID-19
CMS has announced its approval of Florida’s Section 1135 Medicaid waiver request, giving the state greater flexibility to respond to COVID-19. These increased flexibilities include the removal of service barriers; streamlining provider enrollment processes; allowing care to be provided in alternative settings; suspending certain nursing home screening requirements; and extending deadlines for appeals.
$8.3B Coronavirus Funding Bill Approved
During the first week in May, the U. S. House and Senate approved an $8.3 billion funding bill to support ongoing efforts to combat COVID-19 (Coronavirus). On March 6, the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074) was finalized by the president
Ohio Revises Definition of Ambulatory Surgical Facilities
Ohio has released the recently revised definition of an Ambulatory Surgical Facility (ASF), as part of the new 2020/2021 general operating budget legislation. The change expanded the ASF definition, which may require some previously unlicensed facilities to obtain licensure.
New York Updates Quality Measures for Medicaid Managed Care Organizations in the Value Based Payment Program
The New York Department of Health released the 2020 value-based payment (VBP) Reporting Requirements Technical Specifications Manual for Measurement Year (MY) 2019. The report includes an overview of the specific quality measure reporting requirements for each VBP arrangement, as well as a description of the changes to the measure sets from 2018 to 2019.
Update on the Status of Surprise Billing Legislation, February 2020
After much inaction on Capitol Hill, while Congress was consumed with other political matters, major legislative action resumed in attempting to fix the patient surprise billing conundrum. What follows is a recap of the changes and quickly evolving nature of surprise billing legislation. Currently, three main bills are working their way through the House and…
House Ways and Means Releases Surprise Billing Proposal
On February 7, the U.S. House Ways and Means Committee released its proposed Consumer Protections Against Surprise Medical Bills Act of 2020. If passed, the proposal would ban balance billing for emergency care, care provided by a nonparticipating provider in a participating facility, and in other circumstances of misinformation. The proposal also includes provisions to establish a dispute resolution process for out-of-network reimbursement disagreements.
CMS Announces New Medicaid Initiative to Limit Drug Coverage, Keep Rebate Obligations
On January 30, CMS announced the new Healthy Adult Opportunity (HAO) initiative that it will allow states to limit drug coverage under Medicaid without reducing manufacturer rebate obligations.
CMS Issues Additional Guidance on D-SNP Integration Requirements
On January 17, CMS issued a memorandum providing additional guidance clarifying Medicare-Medicaid integration requirements for Dual Eligible Special Needs Plans (D-SNPs). The memorandum is intended to clarify distinctions between fully integrated D-SNPs (FIDE SNPs) and highly integrated (HIDE SNPs); permissibility of carve-outs of behavioral health services and long term services and supports (LTSS) for FIDE SNPs and HIDE SNPs; alignment of D-SNP and companion Medicaid plan service areas; and compliance with integration requirements for DSNPs that only enroll partial-benefit dually eligible individuals.
UHC Issues New ED Professional E/M Policy
UnitedHealthcare (UHC) has announced that starting April 1, 2020, they will use a proprietary software program to evaluate all professional claims submitted for emergency department visits with the Level 5 evaluation and management (E/M) code 99285.
Want to Confirm a High-Level ED Code? Examine the Note
Marie Franklin, MBA. CPC, National Director of Coding, Education, and Audit, AdvantEdge Healthcare Solutions, informs readers in the tci Newsletters ED and Coding Reimbursement Alerts E/M, Want to Confirm a High-Level ED Code? Examine the Note provides the information you need to avoid upcoding your ED services. To read the considerations for ED coding to…
CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
New York Health + Hospitals Expands Health Program for the Uninsured
On October 4, New York City’s public hospital system, NYC Health + Hospitals, established a new program to provide health care to New York City’s uninsured, called NYC Care. The program originally launched in August and has a current enrollment of 5,000 people, and will expand into Brooklyn and Staten Island in January 2020.
CMS Advances ‘Patients over Paperwork’ Initiative Under Final Rule
On September 26, CMS issued The Omnibus Burden Reduction (Conditions of Participation) Final Rule, which advances the ‘Patients over Paperwork’ initiative aimed at reducing administrative costs in healthcare.
Texas to Receive Increase in Federal Funds for Uncompensated Care
The Texas Health and Human Services Commission announced, on October 1, that the state will be given $11.6 billion over the next three years to help reimburse health care providers for indigent services and is intended to benefit hospitals, clinics, public ambulance, and dental providers.
House Ways and Means Committee Chairman Proposes New Approach to End Surprise Medical Bills
In a letter to the House Ways and Means Committee, Chairman Richard Neal has proposed that the Departments of Health and Human Services (HHS), the U.S. Labor and Treasury Department, along with other interested parties, consolidate their efforts to develop standards for rates for surprise bills.
Proposed Legislation Aims to Improve Provider Directories Accuracy
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
