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11/25/2024
Practices that treat patients who were eligible for telehealth services before the COVID-19 public health emergency (PHE) take note: Even though the original telehealth rules and requirements will be restored on Jan. 1, 2025, CMS will hang on to a few waivers, including a permanent change for audio-only services.
11/25/2024
Infectious disease specialists should take note of the user-friendly adjustments and clarifications that CMS made to the final version of the new infectious disease consultant add-on code that will go into effect Jan. 1, 2025. For example, CMS clarified that eligible qualified health care professionals (QHP) can report the service.
11/25/2024
Question: I recently read about a third-party biller who was charged with health care fraud and eventually entered a plea agreement — but the practice he worked for was not charged. I thought fraudulent medical billings were always the responsibility of the provider whose services were billed. Is it possible for a biller to be guilty but not the provider?
11/25/2024
At its core, the National Correct Coding Initiative (NCCI) is designed to reduce improper coding and billing practices across CMS programs. Keep up to date with policy manual changes and the latest modifier guidance to keep your claims accurately processed.
11/25/2024
In the rates for Medicare-payable services codified in the physician fee schedule final rule, losers outpace winners — and the winners aren’t doing so well, either.
11/18/2024
CMS finalized its proposal to relax restrictions on complexity of care add-on code G2211. The changes come in response to stakeholder concerns that the current CMS policy is disruptive to the way providers normally treat patients.
11/18/2024
The changes proposed in the final rule for Medicare’s burgeoning behavioral health category have been finalized, expanding its purview beyond previous therapeutic models and even into digital care engaged by the patients themselves.
11/18/2024
The changes to the Quality Payment Program (QPP) and Merit-Based Incentive Payment System (MIPS) in the physician fee schedule final rule show CMS cautiously pushing forward into new forms of reporting and quantifying provider performance, with a focus on programs such as the Alternative Payment Model (APM) Performance Pathway (APP) Plus quality measure set and MIPS Value Pathways (MVP). The long-term hope is to achieve universal quality reporting for all patients regardless of payer.
11/18/2024
The change of quality reporting method for accountable care organizations (ACO) in the Medicare Shared Savings Program (MSSP) from APP to APP Plus is significant, and will grow even more important with the proposed full switch-over to electronic clinical quality measures (eCQM) in five years. But other bold strokes, like the new prepaid model and the Health Equity Benchmark Adjustment (HEBA), are expected to have a more immediate effect.
11/18/2024
The enhanced care management codes floated in the physician fee schedule proposed rule have been cleared, including “advanced primary care management services” (APCM) that promise to level up primary care treatment of patients with chronic conditions — if their providers can meet the terms.

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