Reimbursement and Payment Methodologies

The 2021 Medicare Physician Fee Schedule (MPFS) final rule, released December 2, extends certain telehealth benefits but makes cuts to the Medicare conversion factor (CF) to offset evaluation and management (E/M) changes that would otherwise have resulted in significant reimbursement increases. Most provisions of the final rule are effective January 1, 2021.

The New COVID-19 Treatments Add-on Payment will allow additional Medicare payment for eligible hospital inpatient and outpatient cases that involve certain new products or treatments authorized or approved for COVID-19.

NAHRI’s October 27 Quarterly Call featured important association updates, an in-depth presentation on optimizing post-COVID-19 reimbursements through a revenue integrity program, and a detailed look at revenue integrity in the age of value-based purchasing and the patient-centered revenue cycle.

COVID-19 patients on mechanical ventilation require intensive care and resources, often for extended periods of time. But gaps in documentation and coding can leave hospitals missing out on earned—and much-needed—revenue and leave crucial holes in patients’ medical records. Use these strategies to ensure appropriate reimbursement for these complex cases.

Put revenue integrity into focus to manage year end changes and ongoing challenges.

Kathryn J. Noorbakhsh, RN, BSN, CPC, CPC-H, shares tips for managing revenue integrity for wound care centers.

Unravel the major proposed changes, including elimination of the inpatient-only list and expanded prior authorization requirements.

Check out these resources for more expert analysis of the 2021 Outpatient Prospective Payment System (OPPS) proposed rule.