Reimbursement and Payment Methodologies

CMS recently boosted Medicare payments for COVID-19 vaccines as part of an effort to accelerate vaccinations.

Six codes for telehealth services are newly eligible to reported with modifier -CS (cost-sharing), which requires Medicare to cover beneficiary cost-sharing during office visits and other encounters for the duration of the public health emergency.

A study published late last year by the Urban Institute forecasted that over 10 million families would lose their employer-sponsored health insurance during the novel coronavirus (COVID-19) pandemic. As a result, healthcare organizations have observed a growing number of uninsured patients and a rise in out-of-pocket responsibility.

Most off-campus provider-based departments (PBD) that claimed the mid-build exception under the 21^st Century Cures Act failed to meet the requirements and have likely received overpayments, according to CMS.

CMS recently released FAQs clarifying how it will collect data on market-based MS-DRG relative weights and changes to its methodology for calculating MS-DRG relative weights.

NAHRI’s Revenue Integrity Symposium (RIS) is a fantastic way to network with and learn from revenue integrity professionals from across the country. But have you considered that RIS can also help hone your professional speaking skills? 

Implementation of two historic rules set to implement interoperability and patient access provisions of the Cures Act, have been postponed until April 5, 2021.