Billing and Claims

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.

CMS will begin reprocessing 2019 claims for certain services rendered at excepted off-campus provider-based departments (PBD), the agency announced. The affected claims are for services represented by HCPCS code G0463 (hospital outpatient clinic visit for assessment and management of a patient). Starting July 1, CMS will reprocess these claims to pay them at the same rate as non-excepted off-campus PBDs, or 70% of the 2019 Outpatient Prospective Payment System (OPPS) rate.

It’s a new year, and NAHRI is excited to provide unique educational opportunities throughout 2021.

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.