As legal and policy developments continue to evolve, hospitals and health care professionals that provide gender-affirming care face new uncertainties regarding federal funding, compliance, and patient access. While these...more Medicaid in the Crosshairs What Restructuring Could Mean for States, Provider...
Patient Reported Outcome-Based Performance measure, with voluntary reporting beginning with CY 2025 and mandatory reporting beginning with CY 2026 and impacting the CY 2028 payment determination. The goal of this measure is to provide insight into the communication...
Key Takeaways CMS issued a J-code for Anktiva, effective January 1, 2025, aiding billing and reimbursement processes for intravesical therapies. Anktiva, approved by the FDA in April 2024, is used with BCG for BCG-unresponsive NMIBC with carcinoma in situ. SHOW MORE The J-code became effect...
2024. CMS finalized the payment and program requirements for the new IOP benefit. The Final Rule includes the scope of benefits, physician certification requirements, coding and billing guidelines, and payment rates under the IOP benefit. CMS finalized its proposal that...
Remote patient monitoring may be catching on with health systems across the country, but its path to Medicare reimbursement is still a work in progress. The Centers for Medicare & Medicaid Services has included a new category of CPT codes in its proposed 2022 Physician Fee Schedule...
AMGA notes that while HHS has made some information and resources available on good faith estimates, there are inconsistencies between guidance for providers and for patients. The letter cites several examples, including patient guidance that states: “[i]f you schedule the item or service at leas...
4. What is the new requirement for using audio-only telecommunications for mental health services? CMS now limits the use of audio-only communications to mental health services when the patient cannot use or does not consent to two-way audio/video technology. A new modifier is required to indi...
Remote patient monitoring may be catching on with health systems across the country, but its path to Medicare reimbursement is still a work in progress. The Centers for Medicare & Medicaid Services has included a new category of CPT codes in its proposed 2022 Physician Fee...
for split (or shared) evaluation and management visits would be based on the amount of time spent by the billing practitioner. The agency has also proposed the extension of several telehealth provisions, such as reimbursement at nonfacility rates for certain telehealth services in a pa...