Q:   Are there any changes to the telehealth billing in 2023? A:  For CY 2023, Medicare is finalizing a number of policies related to services, including making several services that are temporarily available as telehealth services for the Public Health Emergency (PHE) available at least through CY 2023. This allows additional time for the collection of data to help in determining whether or not Medicare will include service(s) as permanent additions to the Medicare Telehealth Services List. Centers for Medicare and Medicaid Services (CMS) has finalized their proposal to extend the duration of time that services are temporarily included on the telehealth services list during the PHE for at least a period of 151 days following the end of the PHE. This confirms CMS' intention to implement the telehealth provisions to ensure a smooth transition after the end of the PHE. These policies, such as allowing telehealth services to be furnished in any geographic area and in any o...

  Amid all the rules stemming from the No Surprises Act, a looming mandate for providers to send cost estimates to health plans looks like the biggest stress inducer. Various regulations under the No Surprises Act have created strain for healthcare finance professionals since the initial rules were published in mid-2021, but one pending requirement is the consensus choice as the heaviest lift. The obligation to provide an advanced explanation of benefits (AEoB) to insured patients will necessitate a level of interoperability between providers and health plans that doesn’t exist. How to make it happen is a vexing question for industry stakeholders. It's uncertain “how anybody’s going to do that, because nobody has the tools yet to make it successful," said Sandy Lood, vice president of revenue cycle with Cottage Health in Santa Barbara, California. The U.S. Departments of Health and Human Services, Labor and Treasury, which together oversee implementation of the No Surprises Ac...

There are many reasons why you should outsource instead of trying to perform your medical billing in house with employees.  One big reason, is fraud protection.  Your hourly employees are only invested in their paycheck.  If they can't figure something out, they have no incentive to find the answer since they don't gain anything by taking the time to get a single, complicated claim paid.  And, they don't care enough to check for fraud risk.  LEVEL Medical Billing is motivated to work EVERY claim; and one of the screens LEVEL has is against fraud.  If we see a claim that has abnormal or potentially fraudulent data, we notify you to make sure there's not a discrepancy.  This saves you time and money against RAC audits, medical record reviews, and legal fees.

  For 90-minute new patient E/M visits and 45-minute return patient E/M visits, annual physician reimbursement was $409,894 under time-based billing and $188,065 under medical decision-making-based billing. Time-based billing was associated with higher physician reimbursement for longer evaluation and management (E/M) visits, while billing based on medical decision-making (MDM) led to higher reimbursement for shorter visits, according to a  study  published in  JAMA Network Open. Under a fee-for-service model, physicians are reimbursed for E/M services based on the number and complexity of problems addressed during a patient’s visit, known as the medical decision-making method. However, physicians may spend time on tasks that are not reportable under  MDM-based billing , such as medical record review, coordination of care, and documentation. This can lead to one to two hours of unreimbursed work for physicians. Time-based billing is an alternative method that re...

  The 2023 CPT code set will update the rest of the E/M code section after significant changes in 2021, as well as revise AI and virtual care codes. The American Medical Association (AMA) has released the Current Procedural Terminology (CPT) code set for 2023, which contains updates that aim to reduce medical coding burden for evaluation and management (E/M) visits. Providers use the CPT code set to document patient visits, including all services provided, and the codes are used to track utilization, measure quality of care, and create medical claims for payer reimbursement. Recently, the documentation and coding requirements for E/M visits were updated by CMS to streamline the process and address administrative burdens. Specifically, in the  2020 Medicare Physician Fee Schedule Final Rule , CMS revised the code descriptors and documentation standards for E/M office visit CPT codes 99201 through 99215 as adopted by the AMA CPT Editorial Panel. Starting in 2021, the agency allo...

  Provider charges for out-of-network care increased by $1,157 after the passage of state surprise billing laws that allow arbitrators to consider provider charges in a surprise billing dispute. State surprise billing laws that allow arbitrators to consider provider charges when determining out-of-network payment amounts for surprise medical bills led to an increase in billed charges for out-of-network care, according to a  Health Affairs  study . Prior to the  federal No Surprises Act , many states passed laws protecting patients from surprise billing. They also established a process to determine the out-of-network rate when  surprise billing occurred . Under state surprise billing laws, payment rates are usually determined by a payment standard or an  independent dispute resolution (IDR) process . Some state laws allow arbitrators to use IDR processes that consider provider charges. The No Surprises Act, which went into effect on January 1, 2022, prohibit...

Ohio Medicaid is 15 days away from activating their new enrollment system from old MITS.  Only time will tell if it is as advertised in being more efficient as a one stop shop for credentialing vs going through each MCOs process.