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All posts by John Aldover

PFS Payment for Office & Outpatient E/M Visits

Effective January 1, for Physician Fee Schedule (PFS) payment of office and outpatient Evaluation and Management (E/M) visits (CPT codes 99201 through 99215), Medicare generally adopted the new AMA coding, language, and interpretive guidance framework. See the fact sheet (PDF) for more information, including: PFS payment of Medicare’s add-on codes for prolonged...

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Improving Accuracy of Medicare Payments

The U.S. Bureau of Labor Statistics (BLS) conducts numerous surveys of hospitals and health care providers that are used by the government to make economic decisions that affect the entire medical care system. Key users include CMS, the Federal Reserve Bank, and the U.S. Congress.  CMS uses these surveys...

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COVID-19 Vaccination FAQs for Employees and Employers

Reference these documents below as you navigate COVID-19 vaccination guidelines. Covid-19 Vaccination FAQs for Employers Covid-19 Vaccination FAQs for Employees   Related links: Covid-19 Related Products Latest News Information provided by CHAP (Community Health Accreditation Partner) on January 26, 2021

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CMS Finalizes Definition of “Reasonable and Necessary”

A definition of “reasonable and necessary” is part of the recently finalized rule,  Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of ‘‘Reasonable and Necessary’’. As previously reported this rule also establishes a Medicare coverage pathway to provide Medicare beneficiaries nationwide with faster access to new, innovative medical devices designated...

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CMS Issues a Workaround for RAPs Without Value Code 61

Home health agencies (HHAs) have had requests for anticipated payments (RAPs) retuned to providers (RTP’d) related to value code 61. With the no pay RAP policy, effective January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is no longer requiring that HHAs report value code 61 and...

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