Coding Resource Center
June 2023
An audit conducted by the Office of Inspector General (OIG) revealed that Medicare overpaid millions of dollars due to incorrect place of service (POS) code reporting in 2019 and 2020. This audit focused on physician services provided for Medicare beneficiaries that were hospital inpatients or in skilled nursing facilities (SNFs); and included analysis of over […]
May 2023
The Public Health Emergency (PHE) for COVID-19 ended on May 11, 2023, and the Centers for Medicare and Medicaid Services (CMS) continues to provide updates to providers, partners and the public related to the end of the PHE:
CMS released a fact sheet that outlines process updates they are making to increase compliance with the hospital price transparency requirements, which went into effect in January 2021 and enforced in July of 2022. The hospital price transparency regulation was authorized by the Public Health Services Act, which allows patients to know the cost of […]
April 2023
On April 10, 2023, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2024. Once these polices become final, they will cover inpatient hospital discharges on or after October 1, 2023. Highlights are described […]
On April 6, 2023, a bipartisan group of physician lawmakers introduced H.R. 2474, “Strengthening Medicare for Patients and Providers Act” in the House of Representatives. This bill links the Medicare Physician Fee Schedule to the Medicare Economic Index (MEI) – a measure of inflation in which physicians are subjected relating to practice costs and wage […]
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 and form instructions, have been approved by the Office of Management and Budget (OMB) for renewal, and will be mandatory for use on June 30, 2023. This form now has an expiration date of January 31, 2026. The ABN form is issued by providers (including independent […]
CMS has awarded Performant Recovery, Inc. the new Recovery Audit Contractor (RAC) contract for Region 2. This affects Arkansas, Colorado, Iowa, Illinois, Kansas, Louisiana, Missouri, Minnesota, Mississippi, Nebraska, New Mexico, Oklahoma, Texas, and Wisconsin. This new RAC is expected to begin reviews in Spring 2023. RACs are responsible for reviewing claims on a post-payment basis […]
March 2023
On March 15, 2023, the Centers for Medicare and Medicaid Services (CMS) issued corrections to the CY 2023 Medicare Physician Fee Schedule (MPFS). The corrections include updates to prolonged services for “Other” Evaluation and Management (E/M) Visits, specifically the time thresholds which must be met in order to bill for prolonged services. The previous times […]
The Medicare Payment Advisory Commission (MedPAC) recommended an increase in fee-for-service pay under the physician fee schedule (PFS) for calendar year 2024. In their yearly report released March 15, 2023, the commission recommended an increase in payments under the PFS payment system by 50 percent of the projected increase in the Medicare Economic Index (MEI). […]
February 2023
The declaration of the public health emergency (PHE) in response to the COVID-19 pandemic brought an onslaught of waivers and flexibilities enacted by the Centers for Medicare and Medicaid (CMS) for beneficiaries to increase access to care, reduce exposure, and ease provider burden. In December 2022, the Consolidated Appropriations Act (CAA) was signed into law. […]
