Coding Resource Center
January 2024
W.L. Gore & Associates announced the first patients have been enrolled in the GORE VBX Forward Clinical Study. This global prospective, multicenter, randomized controlled trial is to “answer the question as to whether covered stents are the superior modality among commonly used devices in contemporary practice.” Specifically, the use of GORE® VIABAHN® VBX balloon expandable […]
Members of Congress will consider legislation which could extend telehealth flexibilities that were a result of the COVID-19 public health emergency, including Medicare reimbursements for virtual visits and access to online care for people who are underinsured: The CONNECT for Health Act would remove geographic restrictions for telehealth services, expanding the originating sites to include […]
The Centers for Medicare and Medicaid Services (CMS) issued the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) The provisions in this final rule impact Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children’s Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) […]
Taken directly from the First Coast Service website: “First Coast requests the following documentation be submitted with the initial claim submission for the T codes linked below: Effective February 26, 2024, when records are not submitted to support the code billed, the service will be rejected. The claim must then be resubmitted with the appropriate […]
December 2023
The bipartisan Lower Costs, More Transparency Act (H.R. 5378) was passed by the U.S. House of Representatives, primarily seeking to provide patients with accurate information regarding the cost of procedures and services. Specifically, the bill requires healthcare price information from hospitals, insurance companies, labs, imaging providers, and ambulatory surgical centers, which would be obligated to […]
The American Medical Association (AMA) recently released new principles for augmented intelligence (AI) development, deployment, and use: Principles for Augmented Intelligence Development, Deployment and Use. While the Food and Drug Administration (FDA) regulates AI-enabled devices, many types of these technologies fall outside the scope of the FDA, such as some clinical decision support functions. Thus, […]
The Medicare Payment Advisory Commission (MedPAC) discussed draft payment recommendations for 2025, which the commission will vote on in January. The draft recommendations call for Congress to update Medicare payment rates for hospital inpatient and outpatient services by the current law amount plus 1.5 percent. CMS is forecasting a 2.6 percent include in the MEI […]
November 2023
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued the final rule for the Medicare Physician Fee Schedule (MFPS). This final rule covers physician services furnished to beneficiaries on or after January 1, 2024. Highlights are described below: The complete MPFS proposed rule summary can be found on the GORE Coding Resource […]
On November 2, 2023, the Centers for Medicare and Medicaid Services (CMS) issued the final 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, 2024. Highlights are described below. […]
On October 27, 2023, The Centers for Medicare and Medicaid Services (CMS) issued the final rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS) for Calendar Year (CY) 2024. This final rule covers renal dialysis services furnished to beneficiaries on or after January 1, 2024. Highlights are described below: The complete […]
