Malignant neoplasm of other and ill-defined sites (195)

Look beyond E/M to get the most out of the final rule. At this point, you’re all too familiar with the 2021 evaluation and management (E/M) shakeup that’s currently underway. The 2021 Medicare Physician Fee Schedule (MPFS) final rule went [...]

Plus: You may not have to give up hope for the rural add-on quite yet. While the news that Medicare officials were pulling HHGM from the 2018 HH PPS Final Rule was met with universal pleasure from the home health [...]

Most specialties will be asked to submit six total measures including one outcome measure and one cross-cutting measure. However, these measures apply exclusively to patient-facing physicians. So, for radiology providers, two additional high priority measures can be used in their [...]

Make sure you have your time thresholds down with this chart from CPT®. Total Duration of Critical Care Codes less than 30 minutes (less than 30 minutes) appropriate E/M codes 30-74 mins. (30 minutes - 1 hr. 14 min.) 99291 [...]

New winners, losers under methodology revamp. Time will be of the essence when it comes to outlier reimbursement come Jan. 1. If the Centers for Medicare & Medicaid Services finalizes its Home Health Prospective Payment System proposed rule for 2017 [...]

Rebasing passes LUPAs by. Home health agencies may feel under-reimbursed for their services to Medicare patients, but at least payment for one type of service continues to rise. As in previous years, the Low Utilization Payment Adjustment payment rates will [...]

Repeated cuts will lead to access problems. The number of home health agencies, users, and episodes continue to fall, but the reimbursement hits just keep on coming. In its proposed rule for the 2017 home health prospective payment system update, [...]

Consolidated billing exception in the works. A rare carve-out for non-routine medical supplies could put more cash in agencies’ hands —but it will come with some billing hassles. Old way: Currently, the Centers for Medicare & Medicaid Services pays separately [...]

Question: Our provider diagnosed a patient with recurrent otitis media and chronic otitis media with effusion. This confuses me because I wasn’t sure which condition she meant. I coded it as H65.196. Was that the right choice? Delaware Subscriber Answer: The patient [...]

An 82 percent increase in Medicaid home health spending over two years has caused one state to initiate a fraud crack-down. MassHealth, the Medicaid program in Massachusetts, has referred a dozen home health agencies to the state’s Medicaid Fraud Division [...]