Billing and Claims

CMS is proposing a 4% decrease to the Medicare conversion factor, permanent expansion of telehealth coverage for some mental health services, and new timelines for Appropriate Use Criteria (AUC) reporting, according to the 2022 Medicare Physician Fee Schedule (MPFS) proposed rule.

Balance billing for emergency services and certain other services will be subject to new limitations, according to an interim final rule with comment period released July 1 by HHS.

Reach the next level of revenue integrity

Brush up on the most recent changes to Medicare’s prior authorization requirements and their operational impact.

Consider how revenue integrity and utilization review teams can work together to meet shared goals.

Gain a fresh perspective on methods to efficiently address patient status changes.

Consider these case studies to understand how to apply condition codes 44 and W2.

Learn how to use regular internal audits and monitoring to boost compliance in revenue integrity areas.

CMS announced an increase in Medicare payment for at-home administration of COVID-19 vaccines. Medicare will now pay $75 per at-home dose, nearly double its previous $40 adminitration rate.

CMS boosted Medicare payment for COVID-19 vaccines administered in the patient’s home to $75 per dose, the agency announced June 9. Prior to June 9, Medicare paid $40 per dose for COVID-19 vaccines administered in the patient’s home.