Proposed Payment Cuts are not good
Advanced Data Systems Corp
Revenue Cycle Management, Practice Management & Medical Billing Software, EHR, and RIS.
In a marriage proposal, one side presents it and the other side can accept or reject it.
In the case of Medicare payment cuts in the annual fee schedule rule, the proposal has been made but this proposal must be rejected.
What’s the proposal? In July, CMS proposed a 3.34% cut to the fee schedule's conversion factor, which is used to calculate Medicare reimbursements. Under the proposed rule, payments overall would decrease by 1.25% compared to 2023. However, CMS set the conversion factor at $32.75, down $1.14 or 3.34% from last year.
What’s the conversion factor? It’s the monetary value assigned to the relative value unit, a key element in how CMS calculates Medicare reimbursements.
CMS said that while it would be decreasing overall payments and adjusting the conversion factor, it is proposing pay hikes for primary care and other services. These increases require cuts elsewhere to achieve budget neutrality, CMS said.
Superior Members Feeling Inferior?
If they do it may be for good reason since about 10,000 of them inadvertently or incorrectly lost their Medicaid coverage after April 1 according to a notice from the Texas Health and Human Services Commission.
The error is being addressed; it’s anticipated coverage will be reinstated soon, if not already by the time you’ve read this. Any denied claims need to be resubmitted within 95 days of the denial date. Otherwise, a specific process must be followed if more than 95 days have elapsed.
Click here for details on the oversight.
CMS Ensuring Protection of Coverage for Children and Families
A letter was sent by CMS to all 50 states, DC, PR, and the U.S. VI requiring them to ascertain if they have an issue with their eligibility systems that could cause people, especially children, to become disengaged from Medicaid or the Children’s Health Insurance Program (CHIP) even if they are still eligible for coverage. The directive requires any discovered deficiencies to be immediately acted on to correct the problem and reinstate coverage.
The impetus is CMS’ belief that eligibility systems are or may be programmed incorrectly to conduct automatic renewals at the family level but not the individual level, even though individuals in a family may have different eligibility requirements to qualify for Medicaid and CHIP.
The thought is that children often have higher eligibility thresholds than their parents, which makes them more likely to be eligible for Medicaid or CHIP coverage even if their parents no longer qualify. This conflicts with existing federal Medicaid requirements and may disproportionately impact children. Click here for the CMS press release.
2024 CPTs: Spanish Descriptors and COVID-19 Code Consolidations
With four months to go prior to the annual January 1st “go” date for updated codes, the AMA has now just released the 2024 CPT? code set which among other changes, addresses language barriers by including Spanish descriptors of medical services as well as other additions, deletions, and revisions totaling 349 changes.
Why are there always annual changes? The CPT Editorial Panel gathers feedback from healthcare stakeholders in the present year to ensure the upcoming year’s codes reflect current coding demands. Obviously, 2024’s coding demands included everything mentioned above.
Of course, English-language descriptors have been in use on medical documents, insurance forms, portals, and more. The AMA feels that adding Spanish descriptors will help CPT users to better assist Spanish-speaking patients. Such coding for 2024 will help improve transparency for patients who speak Spanish with consumer-friendly descriptors for over 11,000 procedures and services.
COVID-related changes:
领英推荐
Evaluation and Management Services (E/M) was also addressed by the CPT board which updated certain time ranges from office/outpatient visit codes, putting them more in line with other E/M codes. The panel added a definition to determine the substantive portion of a split/shared E/M visit in which a physician and a non-physician practitioner work together to furnish services related to the visit.
Also new on the E/M side are coding instructions for hospital inpatient or observation care, admission, and discharge services when a patient’s stay is over two days.
Staying on top of CPTs can be daunting in itself without E/M; adding E/M makes it that much more challenging. And then, doesn’t it seem that just as you start to become familiar with the current year’s codes, you then need to latch onto the following year’s codes?
No Surprises Act Rate Increase shouldn’t be a Surprise
The HHS and other Federal departments have proposed rate increases for the independent dispute resolution (IDR) process administrative fee. What a surprise! And the proposal isn’t to raise it by just a few dollars. If approved, it would be a 200% increase from $50 to $150.
That’s not all: the agencies also proposed increasing the upper limit of the fee range for certified IDR entities by 20% for single determinations and 25% for batched determinations.
If approved, this would all go into effect on Jan. 1, 2024. And click here for a good overview article.
Another No Surprise: Hospitals Cost More than your Practice or Group
Perhaps not surprisingly, costs for common medical procedures were as much as 58% higher when performed in a hospital outpatient department vs. a doctor’s office according to a report by the BCBS Association/Blue Health Intelligence.
Commercial claims data for common outpatient services for 133 million BCBS members from 2017 to 2022 was used to make the determination. These included mammograms, colonoscopy screenings, diagnostic colonoscopies, cataract surgeries, ear tympanostomies, and clinical visits.
Click here for the BCBS press release with detailed breakdowns of the procedures, and know that even though you no doubt derive more than hospitals on these procedures, we still ensure you get maximized reimbursements on all of your claims!
Feature of the Month: Remote Patient Monitoring
RPM empowers you to monitor patients’ vitals remotely and be paid for doing so. You’ll provide a much-needed capability for parents who have difficulty traveling even if they’re close to your practice, and for patients who can travel but who live remotely.
Our RPM option provides equipment, training, and support at no cost, and our systems and team are proficient in RPM billing and claims.
RPM is an ideal adjunct to our Medics Telemedicine app for virtual encounters which also produce revenue while reducing (eliminating) the in-office resources needed for in-office visits.
Contact us for more about our RPM platform, Medics Telemedicine, and all of our power features and options for engagement and mobility, revenue, productivity, clinical charting, and workflow.
Disclaimer: Articles and content about governmental information, such as CMS, Medicare, and Medicaid, are presented according to our best understanding. Please visit www.cms.gov if clarifications are needed. We are not responsible for typographical errors or changes that may have occurred after this newsletter was produced. Visit www.adsc.com to view our most up-to-date information. ADS RCM does not endorse any companies mentioned in our newsletters; you are encouraged to do your own research and due diligence on any that might be of interest.