Tag: #CMS

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, MIPS, MU Stage 2 and 3

CMS 126v4 measure- for year 2017

Posted on by KR2Medical Billing

This is the first post in my “In The KNOW series”

In this episode we look at the  CMS 126v4 measure- Use of Appropriate Medications for Asthma for the Attestation year – 2017 for eligible EPs.

As per CMS FINAL Rule in October 2016- this above measure has been permanently  removed from the 2017 MIPS reporting. This decision was made based on high performance numbers and resulting minimal variation in care.