Reimbursement News

Physicians Call for Fair Reimbursement for COVID-19 Vaccines

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Physicians are asking for adequate reimbursement for all COVID-19 vaccines and their administration, according to a new policy statement from the American College of Physicians (ACP). The statement...

Hospital Uncompensated Care Costs Grew to $41.61B in 2019

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Hospital uncompensated care costs increased right before the COVID-19 pandemic hit, according to new data from the American Hospital Association (AHA). AHA data showed that hospitals incurred a new...

AMA Issues Unique CPT Codes for Janssen COVID-19 Vaccine

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The American Medical Association (AMA) has added new codes to the Current Procedural Terminology (CPT) code set to account for the COVID-19 vaccine candidate from Janssen Pharmaceutica, a division...

CMS to Reprocess Some Outpatient Claims After Site-Neutral Ruling

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CMS has announced that it will reprocess hospital outpatient claims from last year for clinic visit services provided at excepted off-campus provider-based departments. The agency will start...

Clinicians, Tech Help St. Joseph’s Health Increase Charges by $39.6M

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Beth Kushner, DO, always starts lectures with residents at St. Joseph’s Health with a simple philosophy. “You should get paid for everything you do, nothing you didn't do, and make...

CMS Recalculates Medicare Physician Fee Schedule Rates for 2021

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CMS has updated Medicare Physician Fee Schedule rates for 2021 after a COVID-19 stimulus package mitigated budget neutrality cuts finalized in a December rule. The Consolidated Appropriations Act,...

OIG: Direct Wage Index Increases to Low-Margin Rural Hospitals

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Rural hospitals struggling the most financially are not benefitting from a Medicare reimbursement adjustment meant to help providers paying the lowest wages to their employees, according to a new...

AMA Creates CPT Codes for AstraZeneca’s COVID-19 Vaccine

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In anticipation of an emergency use authorization from the Food and Drug Administration (FDA), the American Medical Association (AMA) has created Current Procedural Terminology (CPT) codes for...

HHS Doles Out $24.5B in Latest Provider Relief Fund Distribution

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HHS, through the Health Resources and Services Administration (HRSA), has completed review of Phase 3 Provider Relief Fund applications and will start distributing payments to over 70,000...

US Healthcare Spending Hit High of $3.8T After Rising 4.6% in 2019

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National healthcare spending hit a total of $3.8 trillion in the year before COVID-19 hit, according to a new analysis from the Office of the Actuary at CMS. The analysis published in Health Affairs...

Key Considerations for COVID-19 Vaccine Billing and Coding

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For many providers, the end of the pandemic is in sight with the recent emergency use authorization of a COVID-19 vaccine. And while this may be true, it is just the start of a COVID-19 vaccine billing...

Providers, Lawmakers Say #StopTheCuts to Physician Fee Schedule

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With payment reductions looming for many providers paid under the Medicare Physician Fee Schedule, hundreds of medical organizations and lawmakers are pushing Congress to stop rate cuts finalized in...

Hospitals File Lawsuit to Settle 340B Issues with Pharma

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The American Hospital Association (AHA) and four other hospital organizations are suing HHS after the department failed to enforce 340B Drug Pricing Program requirements when major pharmaceutical...

US Healthcare Spending Declines from COVID-19, But Remains High

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Healthcare spending in the US is declining for the first time in years because of the unprecedented COVID-19 pandemic, according to a new report from the Peterson-KFF Health System...

Hospital Claim Denials Up for Most, Driven by Prior Authorizations

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Hospitals and health systems are facing a growing volume of claim denials, with private plan prior authorization issues driving the recent increase, according to a new report from the American Hospital...

CMS Provides Billing Codes for Regeneron’s COVID-19 Antibody Drug

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CMS has released Medicare billing codes for a new COVID-19 antibody drug recently approved by the FDA. Healthcare providers are now able to use the Healthcare Common Procedural Coding System (HCPCS)...

Hospitals Criticize Major Policy Moves in 2021 OPPS Final Rule

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Healthcare policies designed to boost competition between hospital outpatient departments and physician offices could actually end up harming hospitals during one of the worst financial crises to hit...

CMS Hospital At Home Model Seeks to Boost Capacity During COVID-19

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As many hospitals near capacity during another surge of COVID-19, CMS is allowing some healthcare providers to participate in a new hospital at home program that allows them to deliver acute care...

New ICD-10 Codes, MS-DRG Assignments for COVID-19 Coming Jan. 1

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Come January 1, 2021, CMS will implement 21 new ICD-10 procedure codes for COVID-19 vaccines and therapeutics for the novel coronavirus, including baricitinib and monoclonal antibody treatments. The...

Providers Say They Need More Financial Aid As COVID-19 Cases Rise

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Providers belonging to the American Medical Group Association (AMGA) are citing rising COVID-19 cases as a reason why Congress should pass additional financial assistance. In a letter sent to...