Phone call codes during the PHE range from 99441 to 99443, and are all based on time. In response to the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) made a number of changes that allowed Medicare beneficiaries to access a wider range of telehealth services without having…
Moderna’s vaccine is expected to be shipped to providers nationwide, on the heels of Pfizer’s. A reeling nation couldn’t have asked for a better Christmas present. The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine for individuals 16 and older last week…
The hiatus of audits was short-lived.  The ongoing COVID-19 pandemic and resulting public health emergency (PHE) has brought about massive and quick changes in the healthcare industry, notably among them the temporary suspension of Medicare Fee-For-Service (FFS) audits. The Centers for Medicare & Medicaid Services (CMS) suspended most audits on…
As payors both in government (Medicare) and the commercial arena (private plans) see the recoupment rate of services billed incorrectly or non-compliantly skyrocket, the payor audit is not going away anytime soon. This awareness is now producing more audits of physicians than ever before, directly contributing to higher rates of denials. Audits take time…
The U.S. healthcare system is facing a critical shortage of supplies, including ICU beds. With the rising concern over COVID-19, I decided to look at data to see what our current shortage of ICU beds could be, comparing census data in Medicare cost reports with U.S. Centers for Disease Control…
Hospitals need to submit Medicare bad debt lists on their cost reports. I was working on a project recently, reviewing bad Medicare debts for a client. I noticed a reduction for a code I do not see a lot on a claim with Medicare primary and Medicaid secondary. It was…
It’s a move sure to stir up controversy.  Under a recently passed Centers for Medicare & Medicaid Services (CMS) Final Rule, your Medicare enrollments will be judged not necessarily on your performance but based on your affiliations with other providers and suppliers. Yes, you read that right: “other providers and…
Oct. 1, 2019, marks the beginning of a new era of billing for skilled nursing facilities (SNFs). EDITOR’S NOTE: This article was published on Aug. 1, 2019, in the RACmonitor news and is reproduced today given the approaching deadline for coding compliance. Say goodbye to RUG-IV, and hello to the…
Under PDPM, reimbursement will be driven by coding and documentation. South Florida has historically been a hotbed of healthcare fraud, and there is a long list of those responsible other than Philip Esformes, who was sentenced to 20 years in prison on Thursday for fraud committed in connection with billings…
With the reimbursement so complex and antiquated, should Congress investigate? Medicare reimbursement payments to hospitals for graduate medical education are based on calculations so complicated, it boggles the mind.  The computation for direct graduate medical education (GME) payments starts with an allowable cost per resident (ARPA) determined in the early…