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.
A federal appeals court on December 29 rejected the hospital industry’s attempt to block CMS’ price transparency rule, effective January 1, that requires hospitals to disclose standard charges, including payer-specific negotiated rates, for 300 services.
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.
United Healthcare (UHC) recently announced that it is delaying the implementation date of its unique laboratory code policy. The policy, which was originally set to go into effect January 1, 2021, will be delayed until January 1, 2022.
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.
The American Medical Association (AMA) recently announced a handful of new CPT® codes for reporting COVID-19 vaccine products and immunization administration. The code release includes two vaccine product codes and four vaccine administration codes.
CMS provided clarification on submitting inpatient claims for patients diagnosed with novel coronavirus (COVID-19) without a positive viral test, in an update to MLN Matters SE20015 released September 11.