Coding Resource Center
April 2023
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. […]
January 2023
On January 11, 2023, 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 […]
On January 30, 2023, it was announced that both national emergencies for addressing COVID-19 will end on May 11, 2022, nearly three years after the United States imposed measures to curb the spread of the illness. After repeatedly ensuring at least a 60-day notice of the end of the PHE, the current announcement meets that […]
The Office of the Inspector General (OIG) performed an audit which revealed improper Medicare payments for co-surgeon and assistant-at-surgery services when Part B providers billed these services without the appropriate payment modifiers. The OIG reviewed a randomly selected sample of 100 services rendered by Part B providers between 2017 and 2019 that were billed without […]
The Department of Health and Human Services (HHS) issued an advisory to alert the U.S. healthcare section of new cyberattack threats, specifically the Royal and BlackCat groups that have recently attacked U.S. electronic medical record and practice management software providers using ransomware. Ransomware is a type of malicious software designed to infect computers and servers […]
November 2022
The Centers for Medicare and Medicaid Services (CMS) issued the final rule for the MPFS and HOPPS/ASC These final rules cover physician and hospital outpatient/ambulatory surgery services furnished to beneficiaries on or after January 1, 2023. Highlights are described below: For MFPS: The finalized conversion factor (CF) is $33.0607, which reflects the CY 2022 CF […]
The Centers for Medicare and Medicaid Services (CMS) issued the final rule for the Medicare End Stage Renal Disease (ESRD) Prospective Payment System (PPS). This final rule covers renal dialysis services furnished to beneficiaries on or after January 1, 2023. Highlights are described below: The finalized base rate for the ESRD PPS is $265.57, which […]
