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Per the terms of the Inflation Reduction Act (IRA) signed into law Aug, 16, the payment for biosimilar drugs under Part B average sales price (ASP) reimbursement ticks up from 106% – the cost of the biosimilar plus a 6% provider reimbursement – to 108% starting this month.
Missing: More than 300,000 services that had been reported with 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.)
 
In case you missed it, CMS has slowly been updating its website. The changes look great, but last week’s makeover of the National Correct Coding Initiative (NCCI) section may contain broken links.
 
Payment cuts are in the offing for Part B providers in 2023, along with a series of other projected changes targeting E/M services, COVID-related billing flexibilities and value-based care, according to the proposed 2023 Medicare physician fee schedule released today.
 
After legislative reprieve buoyed fees in 2022, CMS again is taking a hack at its primary rate-setting mechanism. The proposed 2023 conversion factor is $33.08, down $1.53, or 4.4%, from the current-year conversion factor of $34.61, according to the 2,066-page proposed rule.
Critical care billing errors can be a bad habit warns Scott Kraft, CPMA, CPC, auditor for DoctorsManagement.

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