OIG to Audit Medicare Payments for COVID-19 Discharges
HHS’ Office of the Inspector General (OIG) will audit Medicare payments made to hospitals for COVID-19 discharges that qualified for a 20 percent add-on payment under the Coronavirus Aid, Relief,...Home Health Payments Much Lower Than Expected Under New Model
Medicare reimbursement cuts meant to keep home health payments levels during the transition to a patient-based payment system have actually resulted in significant revenue decreases for the providers,...2021 CPT Code Set Simplifies E/M Coding, Adds COVID-19 Tests
The American Medical Association (AMA) implemented major changes to the 2021 Current Procedural Terminology (CPT) code set in an effort to simplify coding and documentation of office visits and...Providers Price Gouging Out-of-Network COVID-19 Tests, AHIP Says
America’s Health Insurance Plans (AHIP) is calling on the government to stop price gouging after finding provider prices for out-of-network COVID-19 tests far exceeded the average cost of...Providers Want Budget Neutrality Waived for E/M Payment Changes
In last week’s release of the proposed 2021 Medicare Physician Fee Schedule rule, CMS confirmed that it will implement changes to evaluation and management (E/M) payments by updating work...AHA Wants More Payback Options for Accelerated Medicare Payments
The American Hospital Association (AHA) is calling on CMS to reconsider repayment options for hospitals that accepted accelerated Medicare payments at the start of the COVID-19 pandemic. For more...Inpatient Rehabilitation Facility PPS Rule for FY 2021 Finalized
CMS is making permanent some regulatory flexibilities offered to inpatient rehabilitation facilities during the COVID-19 public health emergency, according to a new rule. The Inpatient Rehabilitation...CMS Resumes RAC Audits, Other Medical Review Activities
CMS recently resumed medical review activities, including pre- and post-payment reviews conducted by Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs), which were paused...Hospitals Lose Case Challenging 340B Hospital Payment Reduction
An appeals court recently ruled against hospital groups seeking to block a nearly 30 percent reduction in 340B hospital payments to hospitals participating in the federal drug discount program. The...CMS Finalizes 2.2% Boost in Skilled Nursing Facility Reimbursement
In one of three Medicare payment rules recently released by CMS, the agency announced that it will increase skilled nursing facility reimbursement by $750 million, or 2.2 percent, for fiscal year (FY)...In the Final Hours, Providers Prepare for Repayment of Medicare Loans
The clock has run out for many providers who accepted advanced payments from Medicare at the start of the COVID-19 pandemic. For more coronavirus updates, visit our resource page, updated twice...AHA, AAMC Want Rehearing for Hospital Site-Neutral Payment Case
The fight against site-neutral payments for hospital outpatient services is not over for two industry groups. The American Hospital Association (AHA) and the Association of American Medical Colleges...Medical Billing Mistakes for Malnutrition Led to $1B in Overpayments
CMS should recoup the portion of nearly $1 billion that was incorrectly paid to hospitals because of medical billing and coding errors involving severe malnutrition diagnosis codes, HHS’ Office...TX Hospitals to Receive $1B Boost in Medicaid Reimbursement
The gap between what hospitals actually spend to treat Medicaid patients and the Medicaid reimbursement amount for that care will get about $1 billion smaller in 2021. Texas Governor Greg Abbott...Telehealth Billing Increased 8,336% from April 2019 to April 2020
Telehealth billing continued to surge amid the COVID-19 pandemic, with telehealth claim lines increasing by 8,336 percent in April 2020, according to a new FAIR Health data. New data from FAIR...CMS Proposes Medicare Payment for Use of Home Dialysis Machines
CMS is proposing to expand eligibility for an add-on Medicare payment to include certain home dialysis machines. The End-State Renal Disease (ESRD) Prospective Payment System (PPS) rule proposed on...Sponsored by XIFIN
