U.S. Healthcare System Addressing COVID-19 Patient Surge

Centers for Medicare & Medicaid Services (CMS) on 30th March 2020 issued an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. CMS sets and enforces essential quality and safety standards for the nation’s healthcare system, and […]

Telehealth Coverage Expanded for Medicare Beneficiaries

A sweeping expansion of telehealth coverage for Medicare beneficiaries is being implemented to aid in the healthcare needs of those with the coronavirus, or COVID-19. The Centers for Medicare & Medicaid Services (CMS) announced in a March 17, 2020, press release that it will make a temporary change in its reimbursement policy for telehealth services. […]

Billing Guidelines for Chronic Care Management (CCM)

Chronic Care Management (CCM) services are generally non-face-to-face services provided to Medicare beneficiaries who have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient. The Centers for Medicare & Medicaid Services (CMS) recognizes that CCM is a critical component of primary care that promotes […]

Original Medicare Coverage and Payment Related to COVID-19

Diagnostic Tests Medicare Part B, which includes a variety of outpatient services, covers medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. Medically necessary clinical diagnostic laboratory tests are generally not subject to coinsurance or deductible. Medicare Part B also covers medically necessary imaging tests, such as computed tomography (CT) […]

Medical Coding Update for Telehealth

There is three options Medical Coding Update for Telehealth and other communications-based technology services i.e. Telephone calls, Internet consultations, and Telemedicine exams. This information is based on guidelines from the Centers for Medicare & Medicaid Services. 2020 Medical Coding Update for Telehealth 1. Telephone Calls HCPCS code G2012 Description: Brief communication technology-based service, e.g. virtual […]

Medicare Advantage Plan Coverage and Payment Related to COVID-19

Medicare Advantage plan (also known as “Part C”) is an “all in one” alternative to Original Medicare. Medicare Advantage plans cover Medicare Part A and Part B services, and usually prescription drugs covered under Medicare Part D. These plans also may offer extra benefits Original Medicare doesn’t cover. Medicare Part D also called the Medicare […]

Are you correctly Using 99291 and 99292 codes?

Critical care is the direct delivery by a physician(s) of medical care for a critically ill or injured patient. The care of such patients involves decision making of high complexity to assess, manipulate, and support central nervous system failure, circulatory failure, shock-like conditions, renal, hepatic, metabolic, or respiratory failure, postoperative complications, overwhelming infection, or other […]

New Billing Codes for Coronavirus (COVID-19) Lab Tests

Centers for Medicare & Medicaid Services (CMS) took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19). On 5th March 2020, CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 […]

Coding Guidelines for Coronavirus for Medicare Beneficiaries

In the 2nd week of March 2020, Congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. The legislation will allow physicians and other health care professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current coronavirus public health emergency. What is happening in the private health insurance sector remains unclear […]

Under Coding: Avoid At Any Cost

Under coding should be avoided because it results in billing for a lower level of service than was actually provided, leading to lost revenue, inaccurate reimbursement, and potential compliance risks. Accurate coding ensures healthcare providers are fairly compensated, maintains proper documentation of patient care, and helps practices stay compliant with Medicare and other payer regulations. […]

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