Coding Resource Center
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 […]
October 2023
The American College of Radiology (ACR) has added nine new topics to its appropriateness criteria (ACR AC). Among the conditions included in the new additions is Screening for Abdominal Aortic Aneurysm. Introduced in 1993, the ACR AC provides guidance which is developed and reviewed annually by expert panels in diagnostic imaging and interventional radiology, with […]
The Medicare Payment Advisory Commission (MedPAC) is an independent congressional agency comprised of seventeen members established to advise the U.S. Congress on issues affecting the Medicare program, including payments, access to care and quality of care. Part of this advisement is providing “clear and accessible” information regarding how Medicare works. The Medicare Payment Basics are […]
The American Independent Medical Practice Association (AIMPA) was recently launched with its focus to support private medicine across multiple specialties through promotion and protection of high quality, cost-effective care furnished in independent medical practices. This new, national multispecialty advocacy group is comprised of 5,000 physicians representing nearly 200 independent practices; and includes Cardiology, Dermatology, Gastroenterology, […]
The American College of Radiology® (ACR®) along with approximately 50 additional provider groups are pushing to terminate the implementation of Healthcare Common Procedure Coding System (HCPCS) code G2211, claiming implementation will penalize clinicians who do not use the code. Evaluation and Management (E/M) add-on HCPCS code G2211 was finalized in 2021 by the Centers for […]
September 2023
The American Medical Association (AMA) released the 2024 CPT® code set on September 8, 2023. In response to requests by the Centers for Medicare and Medicaid Services (CMS) to clarify the reporting of evaluation and management (E/M) services, the 2024 code set provides revisions to E/M services including: In addition, the AMA now offers Spanish […]
On September 5, 2023, the Centers for Medicare and Medicaid Services (CMS) announced a new voluntary, state total cost of care (TCOC) model, “the States Advancing All-Payer Health Equity Approaches and Development Model” (States Advancing AHEAD or AHEAD Model). The goal is to work with states using hospital global budgets (HGBs) to control healthcare cost […]
The Lower Costs, More Transparency Act (H.R. 5378) was introduced 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 publicly […]
