Part B News | Editors' Blog

CMS sets standards for non-medical services, settings under Medicaid, CHIP

by: Roy Edroso Jan 5, 2023

On Jan. 4 CMS issued new guidelines for the use of non-medical services under Medicaid managed care programs and the Children’s Health Insurance Program (CHIP) – further advancing the agency’s agenda to use such means to meet beneficiaries’ social determinants of health (SDOH).

Near-final version of budget bill dents Medicare cuts, extends telehealth flex

by: Roy Edroso Dec 20, 2022

In what looks to be the last iteration of Congress’ year-end appropriations bill for 2023, the daunting 4.5% conversion factor cut to Medicare providers’ reimbursement has been slightly eased with a 2.5% increase to 2023 rates and a 1.25% increase to 2024 rates – trimming but not totally erasing the drop to about 2% for CY 2023.

CMS extends enforcement discretion on No Surprises Act 'convening provider' rule indefinitely

by: Roy Edroso Dec 6, 2022

Just a few weeks after closing out a Request for Information on its No Surprises Act (NSA) rules, CMS has given anxious providers an early holiday gift: An extension of its enforcement discretion on the convening provider requirements that are part of the Good Faith Estimates (GFE) providers must create for patients.

AMA Q&A session reveals substantive confusion over split/shared guidelines

by: Julia Kyles, CPC Nov 17, 2022

Make sure billers, coders, clinicians and compliance staff understand that the substantive portion rule does not apply to CPT split/shared coding guidelines.

Breaking: CMS finalizes 4.5% rate cut in ’23, confirms E/M trajectory in Medicare PFS

by: DecisionHealth Staff Nov 1, 2022

Start your look-ahead to CY 2023: Payment cuts are coming, significant changes to E/M services are finalized and key reporting revisions are hitting telehealth and audio-only services, according to the final 2023 Medicare physician fee schedule released today.

Proposed payment cuts that drew vocal criticism from physician advocacy groups will move forward as planned, as CMS announced a 4.5% reduction to the CY 2023 Medicare Part B conversion factor (CF), effective Jan. 1.

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