This article written by Michael A. Cassidy and Jerry J. Russo appeared in the October 2020 Issue of the Allegheny County Medical Society Bulletin.
Medicare & Reimbursement
President Trump Issues Surprise Billing Executive Order
By Michael Cassidy on
Posted in Legal News, Medicare & Reimbursement
On September 24, 2020, President Trump issued an Executive Order encouraging Congress to restrict surprise billing and prevent third party payors from denying care to patients with pre-existing conditions. President Trump wants Congress to act prior to the end of the year, but obviously there is not much chance of that happening.
Proposed 2021 Medicare Physician Fee Schedule Changes
By Michael Cassidy on
Posted in Medicare & Reimbursement
Attached is a link to the fact sheet for “proposed policy, payment, and quality provisions changes to Medicare physician fee schedule for calendar year 2021”.
Among other things, Centers for Medicare & Medicaid Services (CMS) proposes to:
- Significantly decrease the Medicare Work Relative Value Unit (WRVU) conversion factor from $36.09 to $32.26
- Significantly revise the
CMS 2021 Fee Schedule Expands ASC Procedures
By Michael Cassidy on
Posted in Articles, Medicare & Reimbursement
Centers for Medicare & Medicaid Services (CMS) published the new hospital outpatient and ambulatory surgical center fee schedule for 2021 on August 12, 2020 at this this link: https://www.federalregister.gov/documents/2020/08/12/2020-17086/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment
As part of the proposed revisions, CMS intends to transfer over 1,500 procedures from the “inpatient only” category, including 266 musculo-skeletal procedures as of 2021, the…
Medicare Physician Fee Schedule Changes: 2020
By Michael Cassidy on
Posted in Legal News, Medicare & Reimbursement
Click here to read Mike Cassidy’s article which was featured in the Legal Report section of the September 2019 edition of the Allegheny County Medical Society Bulletin.
CMS Expands Medicare Advantage Telehealth Coverage
By Michael Cassidy on
Posted in Medicare & Reimbursement
On April 4, 2019, CMS issued the final Medicare Advantage Rule for calendar year 2020, announcing it will allow Medicare Advantage carriers to significantly increase the range of telehealth services beyond traditional Medicare Part B covered services, stipulating only that, if a service is to be covered as a telehealth service, it must also be…
Medicare Updates Ambulatory Surgical Center (ASC) Payment Systems
By Michael Cassidy on
Posted in Medicare & Reimbursement
On Thursday, March 28, CMS issued a new MLN Connects article, which included updates for ambulatory surgery center payments. A link is attached below:
CMS Issues Hospital Price Transparency Rules
By Michael Cassidy on
Posted in Medicare & Reimbursement
As part of the 2019 Medicare annual inpatient prospective payment system (PPS) fee schedule update, CMS has added a “rule” requiring hospitals to publish a list of standard charges beginning January 2019.
CMS explained this initiative under the “Transparency” and “Request for Information” topics in the following link: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2019-medicare-hospital-inpatient-prospective-payment-system-ipps-and-long-term-acute-0
CMS subsequently issued two sets of…
2019 Medicare Physician Fee Schedule Provides Future “Telehealth” or “Communication-Based” Billing Opportunities
By Michael Cassidy on
Posted in Medicare & Reimbursement
The final Medicare 2019 Physician Fee Schedule https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/index.html rule was posted on November 1, 2019, to be effective January 1, 2019. It includes Section II(D) entitled “Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services”, with several subsections.
- Brief communication technology-based services (EG Virtual Check-In) (HCPCS Code G2012)
- Remote evaluation of prerecorded patient information (HCPCS
…
2019 Proposed Medicare Fee Schedule
By Michael Cassidy on
Posted in Medicare & Reimbursement
The 2019 proposed Medicare Fee Schedule was published on July 27, 2018 by CMS at https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf.
Pages 61 through 91 of the Executive Summary are devoted to: Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services. Click here to read: Modernizing Medicare Physician Payment by Recognizing Communication Technology-Based Services.
This subsection is devoted…