Billing and Claims

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.

Q: Can you tell me if your facility charges a triage charge for the ED? If a patient comes in and gets triaged, has vitals taken, protocol for labs, and then leaves, do you charge a Level 1 Triage for this or write everything off? Also, do you charge a suture fee if the patents comes in to ED for just suture removal?

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.

Q: What revenue code should be attached to HCPCS codes M0239 (intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring) and M0243 (intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring)? We set it up as revenue code 260 but are getting edits to change it to 771. What are your thoughts and suggestions?

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.

NAHRI’s January 26 Quarterly Call featured important association updates, as well as presentations on the new price transparency requirements and the 2021 OPPS final rule.