Billing and Claims

It’s helpful to understand payer-specific contract terms and government billing requirements when developing work lists or work queues and reports.

Q: We are a critical access hospital (CAH). We provide smoking cessation therapy (CPT codes 99406-99407) in our cardiac rehab department. The documentation is done and signed by a respiratory therapist (RT), and we are currently billing this as a professional charge (on a UB-04 with revenue code 0981). My question is, can we bill this on a UB-04 as a facility charge only and still allow our RT or other ancillary staff to perform it?

Reach your destination by planning for revenue integrity success.

Consider the financial impact of CMS’ proposals for outpatient hospital payments.

Review CMS’ proposals in the 2023 Medicare Physician Fee Schedule for changes to facility E/M coding and other coverage and reimbursement updates.

Ensure your organization is complying with CMS’ latest requirements for hospital inpatient billing and reimbursement.

A federal judge ruled in favor of the American Hospital Association (AHA) and other industry plaintiffs on September 28, ordering HHS to stop its reimbursement cuts to the 340B Drug Pricing Program for the remainder of the year.

The Office of Inspector General (OIG) recently released an audit report on Medicare integrity risks related to billing for telehealth services during the first year of the COVID-19 pandemic. Although the OIG identified only a small portion of high-risk providers, it acknowledged the need for additional oversight as telehealth continues to grow in popularity.