July 2022
On July 15, 2022, the Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgery Center (ASC) Prospective Payment System. These proposed rules cover outpatient hospital and ASC services furnished to beneficiaries on or after January 1, 2023. Highlights are described below. […]
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On July 15, 2022, Xavier Becerra, Secretary of Health and Human Services (HHS) announced the renewal of the public health emergency (PHE) declared due to the Coronavirus Disease 2019 (COVID-19). The PHE was originally declared on January 31, 2020; and renewed on April 21, 2020, July 23, 2020, October 2, 2020, January 7, 2021, April 15, […]
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On July 1, 2022, the Centers for Medicare and Medicaid Services (CMS) Insurer Price Transparency Rule enforcement went into effect. It was intended to be in effect as of January 1, 2022, but CMS delayed enforcement for six months to allow payers time to adhere to the regulations, including access to machine-readable files for consumer […]
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On July 7, 2022, The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 12769 to suspend outpatient and inpatient prospective payment system (OPPS and IPPS) claims getting an outlier payment when a device credit is reported. This edit will allow Medicare Administrative Contractors (MACs) to review the charges and validate Medicare outlier […]
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June 2022
On December 10, 2021, the Protecting Medicare and American Farmers from Sequester Cuts Act was passed, which impacts payment for all Medicare Fee-for-Service (FFS) claims. This law covered a continued suspension of 2 percent sequestration through March 31, 2022, and subsequently a 1 percent payment adjustment from April 1 – June 30, 2022. For July […]
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The Centers for Medicare and Medicaid Services (CMS) issued the proposed rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS). These proposed rules cover renal dialysis services furnished to beneficiaries on or after January 1, 2023. Highlights are described below: Rebase and revise the ESRD market basket to a 2020 base […]
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The ICD-10 Procedural Coding System (ICD-10-PCS) codes and updates for fiscal year (FY) 2023 have been released, and are available on the 2023 ICD-10-PCS Home Page of the CMS website. These codes are to be used for discharges occurring from October 1, 2022, through September 30, 2023. The update files include official coding and reporting […]
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The FY 2023 ICD-10-CM diagnosis codes have been released by the Centers for Disease Control and Prevention (CDC) and are available on the CDC ICD-10-CM Home Page and the CMS 2023 ICD-10-CM Page. These codes are to be used for discharges and patient encounters occurring from October 1, 2022, through September 30, 2023. The update files include official coding reporting guidelines, […]
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Several changes will be made to the Current Procedural Terminology (CPT®) 2023 code set that will affect diagnostic services and procedures, effective January 1, 2023. Of interest is percutaneous arteriovenous fistula creation. Two new codes will be available for percutaneous or endovascular approaches for creating arteriovenous anastomoses. Currently, there are only codes to describe this […]
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Gore and Associates recently announced U.S. approval by the Food and Drug Administration (FDA) for the GORE® TAG® Thoracic Branch Endoprosthesis (TBE). This device is indicated for endovascular repair of lesions of the descending thoracic aorta, while maintaining flow into the left subclavian artery. This is for patients who have adequate iliac/femoral access, and eligible […]
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