Coverage

Get a fresh perspective on revenue integrity for the new year.

Christian S. Gabriel breaks down CMS’ expanded coverage for hospital outpatient telehealth.

Take a look at the revenue integrity impact of CMS’ changes to telehealth and E/M.

Understand the ins and outs of CMS’ major new policies.

The 2021 Outpatient Prospective Payment System (OPPS) final rule, released December 2, moves ahead with most of the provisions of the proposed rule. This should come as a relief to hospitals required to implement most of its policies by January 1, 2021.

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.

CMS announced on November 25 that it is building on the flexibilities granted by the Hospitals Without Walls program to launch the Acute Hospital Care at Home program. Under this program, eligible hospitals will be allowed to treat certain inpatients in the patient’s home.

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.

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