Centers for Medicare and Medicaid Services Archives

Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied

Among the Centers for Medicare and Medicaid Services’ new codes is one that’s likely to be confusing as patients start coming in for flu shots. A quadrivalent vaccine made and distributed by Sequirus is available for reporting, but if billing staff use the corresponding code, 90756 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) before January 1, 2018, the claim will be denied. Instead, they’re advised …

Most Doctors Say They’re Not Prepared for MACRA

We told you recently that the Centers for Medicare and Medicaid Services lowered the threshold for physicians to be exempt from MACRA’s reporting requirements in 2018. It’s a good thing, too: 75% of physicians involved in practice decision-making say they do not feel well prepared to participate in MACRA’s Quality Payment Program (QPP). The data were just released by the American Medical Association and KPMG. The QPP pushes eligible providers to choose between the Advanced Alternative …

CMS May Have Overpaid $729 Million in Incentives—Now They Want It Back

The Centers for Medicare and Medicaid Services (CMS) may have doled out more than $729 million in incentive payments for use of electronic health record systems that didn’t actually comply with federal standards, according to the Office of the Inspector General (OIG) at Health and Human Services. The OIG has already uncovered instances where providers who received payments could not document that they were using electronic health records in “meaningful” ways—a key requirement to reap …

Health Spending Predictions Favor Urgent Care

The next decade will see national health expenditures grow 5.6% annually, according to projections from the Centers for Medicare & Medicaid Services (CMS), ensuring that the need for cost-effective, high-quality care will continue to grow as well. If CMS’s Office of the Actuary is correct in its estimate, the jump in healthcare spending will outpace projected growth of the Gross Domestic Product (GDP) by 1.2%. The portion of the GDP consumed by healthcare spending is …

Understand the Rules—and Code Correctly—When Charging a Facility Fee

Whether an urgent care can bill Place of Service -19 or -22 requires an understanding of the criteria enabling facility code sets. An urgent care joint venture between physicians and a hospital recently inquired about using Place of Service 22 (Outpatient Hospital), enabling facility fees. The key with billing the urgent care as “outpatient hospital” is that it must truly qualify for that service. I have reservations as to whether the urgent care could bill …