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First payable code shows virtual reality’s advance, as other pay models await

08/07/2023

There’s a lot of talk about virtual reality (VR) in health care, despite the lack of direct reimbursement for its use from payers. Experts say there are current opportunities for VR as an added benefit in some health care settings, and plenty of developmental activity that’s promising for the future. But for most providers, both the patient benefits and the payments may be years away.

Cultivate Medicare prolonged service rule compliance with a decision tree

08/07/2023

by: Julia Kyles, CPC

Use this decision tree to illustrate Medicare’s rules for coding prolonged E/M services. Medicare created codes and rules for prolonged services performed by a physician or qualified health care professional (QHP) because it disagrees with portions of the CPT guidelines.

To boost diabetes program, CMS revamps code set, extends virtual options

08/07/2023

by: Richard Scott

Due to billing confusion, low utilization rates and patient retention challenges, CMS seeks to deliver a sleeker design behind the Medicare Diabetes Prevention Program (MDPP) in 2024. The agency plans to chop the number of HCPCS codes eligible for reporting while maintaining virtual options for patient encounters, according to the proposed 2024 Medicare physician fee schedule released July 13.

CMS to kick 19 therapy codes back to the RUC for review

08/07/2023

by: Laura Evans, CPC

In a potential windfall for therapy practices, CMS stated in the proposed 2024 Medicare physician fee schedule, released July 13, that it would consider revaluing 19 therapy codes to evaluate whether they had been misvalued during their last review five years ago.

Determine key tips for reporting SDOH in ICD-10-CM

08/07/2023

by: Savannah Schmidt

Question: What are some tips for organizations that are just starting out capturing the type of information to report social determinant of health (SDOH) diagnoses in ICD-10-CM?

Remote BPCI codes, E/M services big gainers in proposed PFS fee dollars

08/07/2023

by: Roy Edroso; data reporting by Laura Evans, CPC

Among the services for which CMS proposes to raise reimbursement by the largest percentage in CY 2024, there’s a thread of E/M codes that meet two of CMS’ recent areas of focus – remote services and bundled care.

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