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CMS bats down argument to correct inflation underestimation. The slight increase in hospices’ 2024 payment rates, as compared to the amount proposed back in March, isn’t going to be enough to stave off hard times for many hospices. So say industry representatives after the Centers for Medicare & Medicaid Services (CMS) released its final rule […]
The post Hospices Will Continue To Struggle Under Inadequate Rate Bump appeared first on AAPC Knowledge Center.
Under newly proposed configuration, half of VBP points will come from only two measures. As home health agencies (HHAs) navigate their first year of the Expanded Home Health Value-Based Purchasing (HHVBP) program, Medicare is proposing to change the rules of the game. The Centers for Medicare & Medicaid Services (CMS) wants to swap out the […]
The post VBP Ground Continues To Shift Under HHAs’ Feet appeared first on AAPC Knowledge Center.
But the cost of submitting a dispute may surprise you. The intent of the No Surprises Act, signed into law in 2020, is to protect patients who receive care from out-of-network providers at in-network facilities and air ambulance services from exorbitant and unexpected balance billing. The problem is that not everyone agrees with the rules […]
The post IDR Payment Determinations Resume Under No Surprises Act appeared first on AAPC Knowledge Center.
Keep this table handy to apply new modifiers JK and JL correctly starting in May. Durable medical equipment (DME) suppliers and pharmacies that provide insulin pumps or insulin for pumps need to be aware of the following key points about upcoming Medicare changes under Part B. Comply With the Coinsurance Cap Starting July 1, 2023, […]
The post Changes Are Coming for Billing Insulin in DME Pumps Under Medicare appeared first on AAPC Knowledge Center.
As more health apps flood the market, app developers need to be aware of their responsibilities to consumers. The U.S. Federal Trade Commission (FTC) issued a policy brief on Sept. 15 clarifying when healthcare apps would be subject to Health Breach Notification Rule 16 C.F.R. Part 318 (the Rule). The Rule was created to help […]
The post Apps Fall Under Health Breach Notification Rule, Cautions FTC appeared first on AAPC Knowledge Center.
If your provider furnishes Medicare patients with any of the services or supplies on this list, expect an ADR. Ever wish you had a crystal ball to foresee when a Recovery Audit Contractor (RAC) might send your office an Additional Documentation Request (ADR) letter? Luckily, all you really need is the World Wide Web; RACs […]
The post 10 Service/Supply Claims Under Review appeared first on AAPC Knowledge Center.
Will your utilization data pre- and post-PDGM make you stand out to authorities? As the weeks under the Patient-Driven Groupings Model (PDGM) wear on, more reports of home health agencies (HHAs) cutting therapy visits and staff roll in. Now Medicare officials are telling agencies to cut it out. The Centers for Medicare & Medicaid Services […]
The post CMS Issues Warning Against Cutting Therapy Visits Under PDGM appeared first on AAPC Knowledge Center.
Beginning July 2019, oncologists who are part of the Center for Medicare & Medicaid Services’ (CMS) voluntary Oncology Care Model (OCM) who haven’t achieved a performance-based payment (PBP) will be switched from a 1-sided risk model to a 2-sided risk model. According to an Avalere study, half of those being switched will lose money. Avalere advises […]
The post Oncologists May Lose Money Under OCM Model appeared first on AAPC Knowledge Center.
In the quarterly update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS), a new HCPCS Level II code is being added for anemia management with an effective date of July 1, 2019. J1444 Injection, ferric pyrophosphate citrate powder, 0.1 mg of iron This code is subject to Medicare Part B consolidated billing and, […]
The post Reporting J1444 under ESRD PPS appeared first on AAPC Knowledge Center.