Posts in Reimbursement
No Significant Fraud: CMS findings relieve concerns over Medicare Telehealth during COVID
No Significant Fraud: CMS findings relieve concerns over Medicare Telehealth during COVID

Discover what the OIG found when investigating telehealth billing fraud, what they recommend regarding future CMS oversight, and four takeaways for businesses billing Medicare telehealth services.

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Digital Health, Fraud and Abuse, Medical Practice, Medicare, OIG, Physician Fee Schedule, Regulations, Reimbursement, Remote Monitoring, Telehealth, Virtual Care, Virtual Care ManagementFaisal Khantelehealth, virtual care managemet, remote monitoring, oig, cms, fraud, Medicare claims, billing, risk management, audits, investigations, regulation
The 2023 Medicare Physician Fee Schedule Proposed Rule: Everything You Need to Know Now [video]
The 2023 Medicare Physician Fee Schedule Proposed Rule: Everything You Need to Know Now [video]

Whether you are building a business aimed at facilitating RTM for healthcare providers or growing a direct-to-consumer RTM practice, you know that reimbursement requirements significantly impact several of your most important business decisions.

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Behavioral Health, Digital Health, Medical Practice, Medicare, Physician Fee Schedule, Physicians, Provider, Reimbursement, Remote Monitoring, Remote Patient Monitoring, Regulations, Telehealth, Telemedicine, Virtual Care Management, WebinarNixon Gwilt Law2023 MPFS, reimbursement, behavioral health, chronic pain management, RTM, telehealth
Proposed Changes to Remote Therapeutic Monitoring Reimbursement in the Proposed 2023 Medicare Physician Fee Schedule
Proposed Changes to Remote Therapeutic Monitoring Reimbursement in the Proposed 2023 Medicare Physician Fee Schedule

Stakeholders will be glad to know that CMS continued the RTM conversation with stakeholders beyond last year’s 2022 Medicare Physician Fee Schedule Final Rule (the “2022 Rule”) and directly addressed many of our questions and concerns, including NGL’s recommendations to re-visit the overall code structure to better align RTM with Remote Physiologic Monitoring (“RPM”) and other care management services.

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Digital Health, Physician Fee Schedule, Reimbursement, Remote MonitoringKaitlyn O’Connor, Carrie Nixon, and Casey PappRTM, Remote Therapeutic Monitoring, MPFS, 2023 MPFS, CMS, reimbursement, CPT codes
Top Six Takeaways from the Proposed 2023 Medicare Physician Fee Schedule: New Remote Monitoring, Behavioral Health, and Chronic Pain Care Management Codes and Telehealth Flexibility Extension
Top Six Takeaways from the Proposed 2023 Medicare Physician Fee Schedule: New Remote Monitoring, Behavioral Health, and Chronic Pain Care Management Codes and Telehealth Flexibility Extension

The much-anticipated 2023 Medicare Physician Fee Schedule Proposed Rule from CMS has arrived! More detailed analyses from the Nixon Gwilt Law team will follow, but in the meantime, here are our top takeaways from the 2023 Proposed Rule.

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Physician Fee Schedule, Virtual Care Management, Remote Monitoring, Digital Health, Provider, ReimbursementCarrie Nixon, Rebecca Gwilt, Kaitlyn O'Connor, and Casey Papp2023 MPFS, MPFS, medicare, reimbursement, rpm, rtm, ccm, telehealth, Remote Patient Monitoring, remote physiological monitoring, Chronic Care Management, telebehavioral health, telemental health, CMS
Digital Health Companies: How to choose a business model to bring your consumer-centric care to the market
Digital Health Companies: How to choose a business model to bring your consumer-centric care to the market
Digital Health, Life Sciences, Medical Practice, MSO, Physicians, Regulations, Reimbursement, Remote Monitoring, Remote Patient Monitoring, Telehealth, Telemedicine, Virtual Care ManagementRebecca GwiltDigital Health, regulation, Virtual care, business, market, Telehealth, Virtual care management, virtual care compliance, direct to consumer, friendly PC, friendly physician MSO, provider, healthcare provider, telehealth network, MSO, pharmacy, telepharmacy, mobile medical applications
WEBINAR: New Remote Therapeutic Monitoring and Virtual Care Management Codes in the 2022 MPFS: Everything you need to know
WEBINAR: New Remote Therapeutic Monitoring and Virtual Care Management Codes in the 2022 MPFS: Everything you need to know

We're back with our most-anticipated webinar of the year! If you are interested in leveraging the new RTM codes or learning more about expanded CCM and PCM reimbursement opportunities in the 2022 MPFS, join us on January 19th!

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Digital Health, Physician Fee Schedule, Reimbursement, Remote Patient MonitoringCarrie Nixon and Kaitlyn O'ConnorRPM, RTM, Remote Therapeutic Monitoring, Remote Patient Monitoring, virtual care, Care Management Services, 2022 MPFS, 2022 Medicare Physician Fee Schedule
How RPM Companies Can Leverage the New Remote Therapeutic Monitoring CPT Codes Expected in 2022
How RPM Companies Can Leverage the New Remote Therapeutic Monitoring CPT Codes Expected in 2022

With these new RTM codes set to go into effect January 1, 2022, RPM vendors already in the remote monitoring arena should start preparing now for how they can take advantage of this new reimbursement opportunity.

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Digital Health, Remote Patient Monitoring, Reimbursement, Physician Fee Schedule, FDAKaitlyn O'ConnorRTM, 2022 MPFS, CPT, Remote Patient Monitoring, RPM, Remote Therapeutic Monitoring, SaMD, software as a medical device
3 Key Challenges Facing Tele-dentistry Companies and How to Approach Them
3 Key Challenges Facing Tele-dentistry Companies and How to Approach Them

Dentistry is one of a number of clinical specialties that is taking a creative and innovative approach to delivering care using digital health tools. Most of us are now familiar with Byte, SmileDirectClub, and Candid—these companies are pioneers in the space. However, tele-dentistry has far more potential applications than retail clear aligner services. Tele-dentistry entrepreneurs are building solutions for remote examination of sore or swollen teeth and gums, screening for certain oral diseases and cancers, mobile dental hygiene, dental hygiene education, and more.

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Telehealth, Tele-dentistry, Provider, Digital Health, ReimbursementKathrin (Kat) Lozahdentistry, teledentistry, CPOD, Corporate practice of Dentistry
Telehealth in the 2022 Medicare Physician Fee Schedule: Audio-Only Telehealth for Mental Health Made Permanent, and CMS Punts on Remote Direct Supervision
Telehealth in the 2022 Medicare Physician Fee Schedule: Audio-Only Telehealth for Mental Health Made Permanent, and CMS Punts on Remote Direct Supervision

On November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) finalized the Medicare Physician Fee Schedule for Calendar Year 2022 (the “Final 2022 MPFS” or the “Final Rule”). As we noted in our July article discussing the Proposed 2022 MPFS, CMS made some significant proposed changes to allow for audio-only telehealth in some limited circumstances. In addition, the agency also proposed to enable remote “direct supervision,” which would allow practitioners to supervise clinical staff billing incident to their services as long as they could be available by audio/video communication as necessary.

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Behavioral Health, CMS Programs, Healthcare Reform, Medicare, OIG, Physician Fee Schedule, Regulations, Reimbursement, Telehealth, TelemedicineRebecca GwiltTelemedicine, telementalhealth, 2022 Medicare Physician Fee Schedule, 2022, MPFS, Medicare, telemedicine, CMS, 99441, 99442, 99443, CPT, 93797, 93798, G0422, G0423, G2252
Additional Reimbursement for Chronic Care Management and Principal Care Management Finalized in the 2022 MPFS
Additional Reimbursement for Chronic Care Management and Principal Care Management Finalized in the 2022 MPFS

In the Final Medicare Physician Fee Schedule (“MPFS”) for 2022 (the “Final Rule”) issued on November 2, 2021, the Centers for Medicare and Medicaid Services (“CMS”) added five new CPT codes in the categories of Chronic Care Management (“CCM”) and Principal Care Management (“PCM”) and increased reimbursement for already existing codes in the same categories. Despite stakeholder feedback, CMS refrained from making any changes to the existing rules for obtaining beneficiary consent for CCM and PCM.

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CMS Programs, Digital Health, Healthcare Reform, OIG, Medicare, Physician Fee Schedule, Reimbursement, Telemedicine, TelehealthKaitlyn O'Connor and Reema TanejaCCM, PCM, Chronic Care Management, Principal Care Management, MPFS, 2022, 2022 Medicare Physician Fee Schedule, medicare physician fee schedule, 99437