Posts in Reimbursement
Telehealth Waiver eases Medicare Restrictions during COVID-19 National Emergency -- but may not go far enough

When the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 was signed into law on March 6th, a provision in the Act that waives the geographic and originating site restrictions on telehealth services for the elderly garnered less attention, but could have a very important role to play in combatting COVID-19 - particularly if the waiver authority is further expanded by Congress. Learn more about the emergency telehealth waivers.

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NEW! Medicare to Reimburse for Acupuncture Services

On January 21, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized a decision (under National Coverage Determination (NCD) 30.3.3) to cover acupuncture for Medicare patients, specifically those with chronic low back pain (cLBP).

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How to Get Paid for Patient "e-Visits" under the 2020 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) released the Final Medicare Physician Fee Schedule for CY 2020 (the “2020 MPFS”) on November 1, 2019. The 2020 MPFS finalizes six new CPT codes for e-Visits, providing new opportunities for physician practices to be reimbursed for conducting digital health assessments and evaluations for their patients and for remote patient monitoring companies to add these capabilities to their platforms.

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CMS Finalizes Changes to Remote Patient Monitoring in the 2020 Medicare Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) released the Final Medicare Physician Fee Schedule for CY 2020 (the “2020 MPFS”) on November 1, 2019, finalizing some important changes relating to Remote Patient Monitoring (RPM) services, but leaving many questions unanswered as of yet.

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New CMS Innovation Models: Primary Care First and Direct Contracting

In April, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) announced a new set of payment models meant to allow primary care providers deliver better care at a lower cost to their patients by removing unneccessary administrative and adjust payouts from procedures to outcomes.

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CMS issues Technical Correction regarding "Incident To" Billing for Remote Patient Monitoring

On March 14, 2019, CMS issued “Technical Corrections” to address errors in the 2019 Final Medicare Physician Fee Schedule (“MPFS”) published on November 23, 2018. One of these corrections addresses “incident to” billing by clinical staff, and has important implications for Remote Patient Monitoring under CPT Code 99457.

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How to Get Paid for Remote Interprofessional Consultation between Physicians

Beginning January 1, 2019, physicians and other Qualified Healthcare Providers (“QHCPs”) eligible to independently bill for E/M services can obtain standalone reimbursement for Interprofessional Internet Consultations using CPT Codes 99446-99449, 99451, and 99452.

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CMS introduces CPT Codes 99453, 99454, and 99457 to reimburse for Chronic Care Remote Patient Monitoring

The final 2019 Medicare Physician Fee Schedule (the “Rule”), released on November 1st, creates three new codes in the category of Chronic Care Remote Physiologic Monitoring (“CCRPM”) for (1) initial set-up and patient education, (2) initial device supply, and (3) monitoring data and interacting with patients or caregivers.

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HCPCS Code G2010 reimburses for Remote Evaluation of Patient-Submitted Images and Video

The final 2019 Medicare Physician Fee Schedule, released by CMS on November 1, 2018, includes a new code that physicians may use to bill for remote evaluation of images to determine whether or not an in-person office visit is necessary. Learn more about HCPCS Code G2010 and how it can be used in medical practices.

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How to get Reimbursed for Virtual Check-ins under HCPCS Code G2012

In its Final Rule for the 2019 Medicare Physician Fee Schedule released on Friday, CMS introduced a new code, HCPCS G2012, allowing physicians and other qualified healthcare professionals (“QHCPs”) to be reimbursed for “virtual check-ins” with patients who aren’t sure whether or not their symptoms warrant an in-office visit. Learn more about virtual check-ins and how they can be used by practices.

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MSSP Proposed Rule may mean major changes for Medicare ACOs

CMS recently released a Proposed Rule suggesting significant changes to the Medicare Shared Savings Program, aimed at accelerating the path for providers participating in a Medicare ACO to take on risk for the cost and care of their patient populations. The following is a summary of key changes proposed to the MSSP.

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2019 Medicare Physician Fee Schedule Proposed Rule: How to Get Paid MORE for Remote Patient Monitoring Services

With the July 12, 2018 release of its proposed Medicare Physician Fee Schedule for 2019, CMS further opened the door for use and reimbursement of Remote Patient Monitoring (or Remote Physiologic Monitoring, "RPM") services. In doing so, CMS recognizes the role that new communications technologies play in increasing patient engagement and reducing unnecessary costs.

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