Category: In The Know Series

Posted in In The Know Series, Insurance, Payers and CPT reinbursement, Training

CMS and E/M code reimbursement rate effective 01/01/2018 (if approved)

Posted on by KR2Medical Billing

If approved: effective 01/01/2018 the following rates will apply to the E/M codes*: These are the proposed payments from CMS for providers that bill for Medicare patients. The documentation guidelines 1995 and 1995  will still apply towards inpatient Hospital visits and Commercial payers.

HCPCS code Current non-facility payment rate Proposed non-facility payment rate
HCPCS code: 99201 Current non-facility payment rate: $45 Proposed non-facility payment rate: $44
HCPCS code: 99202 Current non-facility payment rate: $76 Proposed non-facility payment rate: $135
HCPCS code: 99203 Current nonfacility payment rate: $110 Proposed nonfacility payment rate: $135
HCPCS code: 99204 Current nonfacility payment rate: $167 Proposed nonfacility payment rate: $135
HCPCS code: 99205 Current nonfacility payment rate: $211 Proposed nonfacility payment rate: $135
HCPCS code Current nonfacility payment rate Proposed nonfacility payment rate
HCPCS code: 99211 Current nonfacility payment rate: $22 Proposed nonfacility payment rate: $24
HCPCS code: 99212 Current nonfacility payment rate: $45 Proposed nonfacility payment rate: $93
HCPCS code: 99213 Current nonfacility payment rate: $74 Proposed nonfacility payment rate: $93
HCPCS code: 99214 Current nonfacility payment rate: $109 Proposed nonfacility payment rate: $93
HCPCS code: 99215 Current nonfacility payment rate: $148 Proposed nonfacility payment rate: $93
Posted in In The Know Series, Insurance, Training

MVP Health Care and Urgent Care Payment Policy

Posted on by KR2Medical Billing

 

With the number of Urgent Care Centers on the rise since 2015, there were new codes added just to represent where the patient went. However, not all payers had a clear payment policy for those codes. When I used to work for the Urgent Care back in 2015-2016, this was a major billing issue I had to personally deal with.

Here is the most updated Payment policy for Urgent Care codes: S9088 and S9083:

Definition: S9088- the services provided in an urgent carte center

Definition: S9083- global fee urgent care centers

*CMS considers both of these codes as informational codes so there is no reimbursement for them.

According to MVP Health Care effective 12/01/2018 they will adopt reimbursement payment policy “based on the E/M code billed for the services”.

***Providers should bill an appropriate E/M code with a Place of service 20 (URGENT CARE)*** Unless the Urgent care is part of a hospital where the POS (place of service can be 22, outpatient hospital). Article 28 is not recognized by some payers, therefore to avoid unnecessary denials the providers should still bill POS 20.***

 

 

Posted in In The Know Series, Insurance, My services, Payers and CPT reinbursement

Does more GHI patients = more revenue? Year 2018

Posted on by KR2Medical Billing

In recent 2 months or so, I have seen an influx of GHI patients coming to my practice.

Great for business, right?….Well it depends on your preference and financial stability of your practice.

Let me Explain.

In the last year In Network Providers have noticed an increase in “Patient Financial Responsibility” and substantial reductions in payments for certain allergy and immunology CPT codes and/or EM codes.

For Example: CPT code like 99213 carries a $30 co-pay and payment of $17 to the provider or no co-pay and a payment of $40 or co-pay of $10 and a payment of $37 to the provider, or co-pay of $30 and a payment of $24 to the provider.

CPT code 94200- carries a $20 co-pay with no payment at all and a co-pay of $22 for CPT code 95117 with no additional payment.

Respectively lower payments compare to other payers.

Providers started to notice this trend and slowly but surely some of them started to either stop accepting new GHI patients or completely stop accepting GHI insurance all together, like ENT.

So should you accept more GHI patients? Well, it is up to you.

I personally created a specific form for GHI patients- informing them of new changes and their new Patient Financial Responsibilities. I let the patients have options to either choose to perform certain services and pay respective co-pay or opt out completely.

Now it is your turn: have you seen an increased amount of GHI patients in your practice? Do you even accept GHI?