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    Welcome to the ClaimCare Medical Billing Blog. We strive to provide content that improves the overall quality of medical billing efforts across the US. If you have any specific topics that you would like to see addressed in this medical billing blog please post the topic in the Medical Billing Questions & Answers Forum. If you have an article that you would like considered for publication in the medical billing blog then please email your article to resources@claimcare.net.

    MEDICAL BILLING BLOG

    What Does Today's (5/11/2023) End of the COVID PHE Mean for Providers?

    Posted by Carl Mays, ClaimCare President/CEO on Thu, May 11, 2023 @ 02:02 PM

    Medical Billing ExpertsThe Biden Administration is ending the COVID19 Public Health Emergency May 11, 2023. This blog is intended to assist you with that transition which includes important coding andImpact of the Proposed 2019 Medicare to the Medical Billing of Ambulatory Surgical Center Services billing items that will change because of the end of the PHE. Even if you believe that you are no longer involved in the treatment of or diagnostics for COVID, if you are doing any kind of remote patient care, laboratory, or Telemedicine then you will need this information moving forward. It is hard for a medical provider to be Medical Billing Experts on all relevant topics. ClaimCare is here to help. 

    ClaimCare Medical Billing Services has remained diligent in our billing efforts, compliance efforts, and client direction, to ensure that our clients have been reimbursed the maximum amount allowable. At the beginning of the Pandemic, we encouraged all of our clients to perform eligibility prior to services being rendered. That process should remain in place. Eligibility issues will continue to be a priority, so we encourage you to monitor that process going forward and ensure it is being fully utilized in your workflow.

    Major bullet points that will impact your practice and/or COVID related business going forward:

    • Telehealth Services
      • Telehealth services will continue to be allowed through the end of 2023. CMS expects to continue this service to Medicare Recipients as it has proven to enhance patient outcomes. Providers should continue to use CPT codes as if they were in person visits with modifier 95 to indicate services were delivered via telehealth.
      • Telehealth does NOT require video beyond the pandemic if the patient does not have a smart phone or computer.
    • COVID Treatment
      • COVID Vaccines are still covered 100% with no patient co-insurance/deductible. Do NOT use the CR modifier after May 11th.
      • COVID Booster still covered 100% with no patient co-insurance/deductible. Do NOT use the CR modifier after May 11th.
      • Treatment via oral anti-viral will continue to be covered without patient co-insurance after May 11th Do NOT use the CR modifier after May 11th.
      • Private Insurance is required to cover Vaccines and treatment for COVID19 with no co-insurance. Do NOT use the CR modifier after May 11th.
      • Diagnosis coding for COVID related services should still utilize ICD-10 Z20822
    • COVID Testing
      • After May 11th, all testing must be ordered by a physician or other eligible provider.
      • Lab U0003, U0004, and U0005 will not be covered beyond May 11th. Revert to the usual PCR testing. You should choose the test that best describes the actual test you run.
        • Most Labs do not report a range (quantitative results) It is typically reported as a positive or negative. In this instance, it is recommended that you choose 86413 if you DO report quantitative results. If you do NOT report quantitative result, choose 86769. (this is for PCR testing only) Refer to the actual lab test that you report on to choose the closest CPT code for the test you bill.
      • Labs are no longer required to report to CDC after May 11th.
      • Labs are no longer required to post prices on their website for price transparency beyond May 11th.
      • G2023 and G2024 will no longer be covered (lab specimen collection) beyond May 11th.
      • 99211 will no longer be utilized for specimen collection beyond May 11th.
      • Over the Counter COVID Tests will no longer be covered beyond May 11th except for Medicaid plans. Medicaid plan members will be able to obtain OTC COVID tests through December 2023.
    • Miscellaneous
      • Virtual Supervision stays in effect through the end of 2023.

    Please reach out to the ClaimCare team if you have any questions.

    ClaimCare has 30 years of medical billing experience. We have an established 100% USA-Based medical billing team that has been assembled through a thorough pre-employment screening. All personnel participate in on-going training and strong process management to ensure they deliver only the highest quality medical billing services to clients.

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2021-2022 recognition. 

    For more information, contact sales@claimcare.net, or phone toll-free at (855) 376-7631, or visit the ClaimCare Medical Billing Company website. We can assist your practice and/or facility in numerous ways, including complete credentialing processing.

    Tags: CMS Update, telemedicine, Center for Medicare and Medicaid Services, CARES Act, COVID

    April 3, 2020 Update to Medicare Telemedicine Notification

    Posted by Carl Mays, ClaimCare President/CEO on Fri, Apr 03, 2020 @ 06:29 PM

    April 3, 2020 Update to Medicare Telemedicine Notification

    telehealthmedicareAt 2:45 this afternoon, CMS notified all providers via Special Edition Message that CMS has made yet another change in the coding requirements for Telemedicine/Telehealth services. Pointed out below are the most critical changes, which pertain to place of service and modifier utilization. Here is the original April 1 Telemedicine Blog Post  that contains the earlier CMS information to which we are now referring. Comparing the April 1 blog to this updated blog will make things less confusing to you. 

    04-03-20 Revised Special Edition Telemedicine Message from CMS

    Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. We will notify you when those services are clearly identified.

    For professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), telehealth claims need to be billed with:

    checklist

    • Place of Service (POS) equal to what it would have been had the service been furnished in-person. This means you no longer use the 02 Place of Service.
    • Modifier 95, indicating that the service rendered was actually performed via telehealth.
    • As a reminder, CMS is not requiring the CR modifier on telehealth services.

    For telemedicine claims already billed with the “02 Place of Service,” medical billers actively monitoring these claims should show them as having been received and in process.  So, it appears this updated change will only impact claims from today forward. Your medical biller should notify you if they find any problems with older or new telemedicine claims. 

    ClaimCare remains on top of all things that impact practices and will continue to monitor these updates.  You may have numerous resources sending information to you. Make sure your medical biller vets every piece of information that is sent to you to ensure its validity.  

    We certainly hope you and your staff are staying safe and healthy during this crisis. We encourage you to share with everyone, staff and patients alike, that they can keep updated on the news and recommendations on the government’s Coronavirus.com website.

     

    About ClaimCare

    ClaimCare is a 100% USA-based HIPAA-Compliant Medical Billing Company

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.

    For additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in numerous ways.

    Tags: medical billing coding, COVID-19 Medical Reimbursement, Medicare Billing, Telehealth, CMS Update, Practice Cash Flow

    March 31, 2020 - Latest  Telehealth CMS Update Provides More  Relief For Providers Serving Patients Through Telemedicine

    Posted by Carl Mays, ClaimCare President/CEO on Wed, Apr 01, 2020 @ 06:05 PM

    telehealth-2CMS released another important update to the ever-evolving emergency telemedicine rules. As ClaimCare has explained in earlier posts during the COVID-19 crisis, one thing is certain: “As we learn more, more things change.” This stands true with the eligibility, coding and claims processing for telemedicine.  ClaimCare has highlighted some key points for you that include the latest changes from today’s CMS update. The current CMS    report titled Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 lists all the CPT codes that CMS is now allowing due to the National Health Disaster.

     

    Key Points that Make Telemedicine Easier and Better

    • Removes barriers for physicians, nurses and other clinicians to be readily hired from the community or from other states so the healthcare system can rapidly expand its workforce.
    • Increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home.
    • Puts patient care FIRST before paperwork to give temporary relief from the many reporting and auditing requirements, allowing providers, healthcare facilities, Medicare Advance and Part D plans and States to focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.
    • Allows clinicians to now provide these services to established and new patients.
    • Allows ANY kind of telemedicine service (see attached list of CPT codes to use).
    • Removes Frequency guidelines.
    • Where a face-to-face visit was required in the past, those guidelines do not apply during the national health emergency.
    • Supervision requirements will not apply during the crisis, but Supervision where previously required will be allowed via teleconference with the Supervising Provider.
    • Postpones ALL re-validation requirements.

     

    Very importantly, CPT Codes have changed and expanded (again)!  There are numerous codes that can now be billed via Telehealth that could not previously be billed. It is imperative when documenting in your systems you notify medical billers that you provided these services via telemedicine.  Medical billers are required to use the appropriate place of service as well as the correct modifiers. 

     

    ClaimCare recommends you indicate in the visit type that (1) it is a telehealth visit (2) you have obtained verbal consent from the patient and (3) consent is documented in the chart. Virtual-Doctor Although the current CMS report articulates the suspension of audits, we encourage you to complete the documentation that you normally would and are ABLE to complete in the chart during the telemedicine visit.

     

    About ClaimCare

    ClaimCare is a 100% USA-based HIPAA-Compliant Medical Billing Company

    new

    ClaimCare has once again been named a “Top 10 Medical Billing and Coding Company.” The honor this time comes from MD Tech Review. The magazine’s Augmenting Medical Billing and Coding Operations article presents solid reasons why ClaimCare has been chosen for this 2019-2020 recognition.claimtag

    For additional information, contact sales@claimcare.net, or phone toll-free (855) 376-7631, or visit the ClaimCare Medical Billing website. We can assist your practice and/or facility in numerous ways.

    Tags: Telehealth, CMS Update

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