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10/28/2024
Adding to its other pioneering prescription drug programs under Medicare, the Biden administration announced Oct. 9 that it would issue a request for information (RFI) on a potential “Medicare $2 Drug List Model” that would make some much-used drugs for hypertension, high cholesterol and other common conditions available to Part D beneficiaries for a couple of bucks.
10/28/2024
Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) continues to see high utilization. Providers reported it on more than 65 million claims in 2023.
10/21/2024
Get ready to dig into more than 400 code changes as part of the 2025 CPT code set. That includes 270 new codes, including dozens of surgical codes, as well as 112 deletions and 38 revisions.
10/21/2024
A big drop in the star ratings for Medicare Advantage plans is just the latest in a series of recent challenges to the public-private coverage program. MA enrollments are increasingly up and set to outstrip traditional Medicare, but challenges like this one are increasingly noisy. While this doesn’t mean the program will reverse course, some payers already are making big changes to cope.
10/21/2024
Take in the details of the 16 new telemedicine codes for real-time encounters in the CPT 2025 manual while you wait to see whether private payers adopt the services or CMS sways from proposed non-coverage of the codes.
10/21/2024
The 2023 Medicare utilization numbers for remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) are in, and the results show all of them up from the previous year, with some services rising sharply.
10/14/2024
A major medical group association sounds the alarm on the effect of impending Medicare cuts on physician practices, and experts agree that, if Congress doesn’t act, the alternatives are either longer hours for providers or cuts in staff and services. Yet there are options you can try to partly stanch the financial bleeding.
10/14/2024
Medicare patients who qualify for the new preventive service designed to protect them from the human immunodeficiency virus (HIV) will be eligible for up to eight counselling and screening services a year, according to the final version of the Preexposure Prophylaxis (PrEP) Using Antiretroviral Therapy to Prevent HIV Infection determination.
10/14/2024
The seventh quarter of the Medicare Prescription Drug Inflation Rebate Program kicked off this month with 54 Part B drugs for which Medicare beneficiaries will be given price breaks on coinsurance, some in the four-figure range.
10/14/2024
Brush up on the ins and outs of the visit complexity add-on code to secure extra dollars when billing it alongside appropriate E/M visits. In January 2024, CMS released guidance for the implementation of the office and outpatient (O/O) E/M visit complexity HCPCS add-on code G2211.

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