Will Your Medical Billing Payer Mix Change in 2022?

Have you noticed changes in your medical billing payer mix? We explain what impacted payer mix in 2021 and what is likely to change in 2022.

Physician Billing in 2022: 10% Medicare cut!

Physician billing rates for 2022 are now official with publication of the Medicare Physician Fee Schedule Final Rule. It includes the 9.75% cut from the earlier Interim Rule, some tweaks to telehealth and QPP/MIPS updates

Will Radiology Reimbursement be Slashed in 2022?

2022 Radiology reimbursement continues to be a very hot topic. While there is nothing official to report, there has been an avalanche of lobbying and letter writing including dire predictions for what could happen if the lower radiology billing rates go into effect. 

A 10% Cut to 2022 Physician Reimbursement?

Covid Vaccine Shot Reimbursement Increased

CMS has updated Medicare Reimbursement for Covid vaccine shots including boosters to approx $40. Plus $35 for home administration.

Repayment of COVID-19 Accelerated and Advance Payments

If a provider received a COVID-19 accelerated or advance payment, CMS is starting to recoup any outstanding balance from the provider’s Medicare payments. 

Repayment of COVID-19 Accelerated and Advance Payments Underway

If a provider received a COVID-19 accelerated or advance payment, CMS will recoup any outstanding balance from the provider’s Medicare payments. This began March 30, 2021, but generally starts on the one-year anniversary of when the provider received their first accelerated or advanced payment.

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.

CMS Provides MIPS Reporting Relief and Extension

CMS is issuing an extension to the 2019 data submission deadline through April 30, 2020. Specifically, the agency is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission.

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.

Pennsylvania Governor Announces Coverage for COVID-19 Testing for Medicaid and CHIP Beneficiaries

Pennsylvania has announced the state’s Medicaid program and Children’s Health Insurance Program (CHIP) will cover COVID-19 testing and treatment for beneficiaries when deemed necessary by a health care practitioner. Additionally, the state says it will also ease some prior authorization requirements to facilitate access to necessary testing and treatment.

Anthem – Information for Care Providers about COVID-19

Anthem Blue Cross and Anthem Blue Shield (Anthem) has developed a list of frequently asked questions regarding administrative processes and recent changes related to COVID-19.

Aetna Issues Letter to Providers: COVID-19 – Taking Action

Aetna has issued a letter to providers detailing the steps the insurer is taking to ensure beneficiaries have access to testing and treatment for COVID-19.

HHS Releases Final Interoperability Rules

CMS and the Department of Health & Human Services (HHS)’ Office of the National Coordinator for Health Information Technology have released two interoperability rules. The new rules aim to make it easier for patients to access and share their information and aim to end information blocking by requiring public and private entities to securely share health information with patients and penalize those who fail to do so.

CMS Seeks to Extend Joint Replacement Model by Three Years

CMS’ Center for Medicare and Medicaid Innovation is proposing a three-year extension for the Comprehensive Care for Joint Replacement (CJR) Model. The new rules proposes to change the definition of an episode to include outpatient hip and knee replacements as well as calculation modifications for the basis for the target price.

$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

HHS Releases Final Recommendations on Reducing Clinical Burden

The U.S. Department of Health & Human Services (HHS) released the final version of its Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. The strategy aims to reduce clinician burden through incremental changes that will push of electronic health record systems toward interoperability while easing regulatory burden.

New Hampshire Joint Legislative Committee Approves New Medicaid to Schools Rule

The New Hampshire Joint Legislative Committee on Administrative Rules has approved changes to the state’s Medicaid to Schools program, which will allow eligible school districts to be reimbursed for providing health care, rehabilitation, and therapy services for children covered by Medicaid.

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.