Category: CMS
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Proposed 2023 physician pay schedule deepens Medicare’s instability
The Medical Association is working with the AMA and many national specialty societies to analyze and comment on CMS proposed 2023 fee schedule. The following article was prepared by the AMA and outlines efforts to address problems that have been identified with the proposed fee schedule: After a thorough analysis, the AMA has weighed in with…
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CMS Issues COVID-19 Health Care Staff Vaccination Interim Final Rule
by Lindsey Phillips, Burr & Forman, LLP On November 4, 2021, the Centers for Medicare & Medicaid Services (“CMS”) announced its interim final rule regarding vaccination requirements for eligible staff of certain healthcare providers. The rule, which becomes effective on November 5, 2021, is expected to apply to approximately 76,000 healthcare providers and cover over…
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Telehealth in Alabama during COVID-19 Public Health Emergency (PHE)
prepared by Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC March 19, 2020 The most important thing to remember is that payers have differing definitions of what they consider telehealth. I recommend checking with the applicable insurer for the most up-to-date information affecting requirements for coding and billing of telehealth services. A few things…
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Appropriate Use Criteria for Advanced Diagnostic Imaging
Contributed by: Gregg Everett, Gilpin Givhan The Protecting Access to Medicare Act (PAMA) was passed in 2014. PAMA required the Centers for Medicare and Medicaid Services (CMS) to establish a program that promotes “Appropriate Use Criteria” (AUC) for advanced diagnostic imaging. AUC’s are evidence-based criteria that assist professionals who order and furnish certain imaging services…
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CMS Releases Physician Fee Schedule Final Rule
The Centers for Medicare and Medicaid Services (CMS) released its final rule for the CY 2020 Physician Fee Schedule. The Medical Association and the AMA will continue to review the rule and analyze these policies in the coming weeks. Attached is a summary of some of the policies CMS finalized in the rule. Some of…
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E/M Code Changes: A Deeper Dive at What Could be Coming for 2021
This is the second in a series of articles reviewing notable changes in the 2019 Physician Fee Schedule Final Rule and provides a deeper discussion of the potential changes to the E/M Coding regime scheduled to take effect in 2021. For the original article, please see Evaluating and Managing the E/M Codes for 2019 and…
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CMS Announces New Medicaid Opportunity to Expand Mental Health Treatment Services
The Centers for Medicare & Medicaid Services recently sent a letter to State Medicaid Directors outlining existing and new opportunities for states to design innovative service delivery systems for adults with serious mental illness and children with serious emotional disturbance. The letter includes a new opportunity for states to receive authority to pay for short-term…
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Evaluating and Managing the E/M Codes for 2019 and Beyond
Editor’s Note: This article is the first in a series of articles about notable changes in the 2019 Physician Fee Schedule Final Rule. In the 2019 Physician Fee Schedule (“PFS”) Proposed Rule, the Centers for Medicare and Medicaid Services (“CMS”) proposed some major changes to the PFS, including changes to the way Evaluation and Management…
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CMS Releases Physician Payment Rule
This week CMS released the final physician payment rule for CY 2019. In addition to the changes to the physician fee schedule (slightly higher than the CY 2018 rate), the rule expands payment for telehealth and aligns physician interoperability requirements with hospital requirements and allows more flexibility in the physician quality reporting program. The rule…
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CMS Updates LCD Determination Process
On Oct. 3, 2018, the Centers for Medicare and Medicaid Services announced updates to Chapter 13 of the Medicare Program Integrity Manual, which deals with Local Coverage Determinations. According to CMS, the updates are intended to “increase transparency and patient engagement.”[1] These changes call for informal meetings with interested parties before a formal request is…