Billing and reimbursement

Modifier -22 indicates that the procedural work performed by the provider or surgeon was substantially greater than what is typically required. The application of this modifier allows providers to receive additional reimbursement for a procedural service that was especially challenging, time-consuming, or unusual.

CMS released the fiscal year (FY) 2020 Inpatient Prospective Payment System (IPPS) proposed rule May 11, which includes just shy of 600 ICD-10-CM code changes. Proposed changes include 490 code additions, 47 revisions, and 58 invalidations, slated to go into effect October 1.

Q: Should providers be documenting the time for all telehealth and telemedicine visits?

CMS is proposing that hospitals report inpatient payer-specific median negotiated rates with Medicare Advantage organizations and third-party payers on the hospital cost report, according to the fiscal year (FY) 2021 Inpatient Prospective Payment System (IPPS) proposed rule.

Navigating Medicare’s rules for charging for ancillary services, bedside procedures, and supplies is no easy task. Get an expert perspective on how to apply the rules.

CMS updated its novel coronavirus (COVID-19) fee-for-service billing FAQs on April 23 and May 1. The updated FAQs address the appropriate use of disaster-related modifiers, remote physiological monitoring (RPM), and more.

Shannon McCall, RHIA, CCS, CCS-P, CPC, CEMC, CRC, CCDS, CCDS-O, reviews the latest guidance and ICD-10-CM reporting for common novel coronavirus (COVID-19) scenarios such as reporting for patients who present for testing with symptoms of COVID-19.

Q: What titles should be considered necessary members of a revenue cycle compliance committee? What structure should it follow?

In an interim final rule with comment period (IFC) issued April 30, CMS makes financial adjustments to benefit Accountable Care Organizations (ACO) and grants greater flexibility to home health providers for the review and certification of patient care plans.

CMS released a new interim final rule with comment period that grants organizations another round of flexibilities to meet the challenges of the COVID-19 public health emergency, including permitting hospitals to bill for telehealth services and loosening restrictions on COVID-19 testing.