Q: How can we submit a claim that hits an edit for a noncovered procedure? Can we submit a claim for the covered procedures? Can we appeal if the provider believes the procedure should be covered?
Medicare increased payments for patients diagnosed with the novel coronavirus (COVID-19). MLN Matters SE20015, implements provisions of the Coronavirus Aid, Relief, and Economic Security (CARES) Act for hospitals paid under the Inpatient Prospective Payment System (IPPS), long-term care hospitals (LTCH) PPS, and inpatient rehabilitation facilities (IRF) PPS.
On January 1, 2021, hospitals will enter a new world of price transparency. CMS put hospitals on track to face expanded price transparency requirements with a final rule released November 15, 2019.
CMS on April 14 released a ruling that nearly doubles Medicare Part B payment for rapid-result COVID-19 laboratory tests from about $51 per test to $100 per test. The payment increase applies to tests performed on or after March 18 and remains in effect until the end of the public health emergency.
CMS updated its novel coronavirus (COVID-19) billing and coding FAQs on April 9 to address new information on payment for specimen collection, diagnostic laboratory services, and hospital services including temporary expansion sites.
Under both the 1135 waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act, CMS is increasing access to Medicare’s telehealth services to allow beneficiaries to receive professional healthcare services without having to travel to a healthcare facility.
The U.S. Department of Health and Human Services (HHS) will reimburse hospitals at Medicare rates for treating uninsured novel coronavirus (COVID-19) patients.
To code for spinal excisions and decompression procedures, coders must break down provider documentation to determine the surgical approach utilized and surgical specialists involved, and in some cases, visualize how the procedure was performed across multiple levels of the spinal column.
