Modifier -25 for Minor Retina Surgeries

The growth of intravitreal drug therapy for the treatment of retinal diseases over the past decade has been unprecedented. The number of intravitreal injections performed annually in the United States rose from less than 3000 in 1999 to more than 1 million in 2008, and it is estimated that more than 7 million intravitreal injections […]

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FAQs on Medicare Billing for Physicians in COVID-19 Pandemic

CMS is revising certain Medicare regulations to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in the Medicare program during the public health emergency (PHE) resulting from the COVID-19 pandemic. To that end, the IFC makes temporary changes to certain policies that will affect Medicare billing […]

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Newly Added Lab Specimen Collection HCPCS Codes COVID-19

CMS announced the creation of new COVID-19 lab specimen collection HCPCS codes G2023 and G2024 through their COVID-19 Interim Final Rule effective on and after March 01st, 2020. The rule specifies that these codes are only chargeable by independent laboratories and only in instances where trained personnel from the lab travel to collect the specimens […]

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Tracking Key Metrics for Laboratories and Diagnostic Providers

Tracking key metrics like clean claim and write-off rates is key to laboratories and diagnostic providers maximizing revenue. Submitting clean claims is one of the most important ways that a diagnostic organization can ensure payment in a timely manner from both private and government insurance payers. Receiving the maximum reimbursement the first time a claim […]

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Newly Added CPT Codes for COVID-19 Antibody Tests

The American Medical Association (AMA) on April 10, 2020, announced updates to Current Procedural Terminology (CPT®) that include two CPT Codes for COVID-19 Antibody Tests, intended to report when patients receive blood tests that detect COVID-19 antibodies. The updates were approved during a special meeting of the CPT Editorial Panel, the independent body convened by […]

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How to increase patient collection in 2020?

As more healthcare bills go to patients themselves, many hospitals and health systems find their existing collections strategies fall short. Traditional solutions are built to collect from insurance companies, not directly from patients. This practice leaves providers exposed to an unpredictable financial landscape where the health of their revenue cycle rests on their patients’ ability […]

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Telehealth Coverage Policies during COVID-19 Pandemic

Updated on April 6, 2020, as things rapidly develop regarding what we know about COVID-19, telehealth coverage policies have also been developing alongside it. Below is a summary of what is covered by various public and private payers with the information that has been released. Medicare Fee for Service Telehealth Coverage SUBJECT AREA CURRENT POLICY […]

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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. […]

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Skilled Nursing Facility 3- Day Rule Waiver

CMS is waiving the requirement at Section 1812(f) of the Social Security Act for a 3-day prior hospitalization for coverage of a skilled nursing facility (SNF 3- Day Rule Waiver) stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who need to be transferred as a result of […]

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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 […]

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