Resource-based relative value scale (RBRVS) is a method used to determine how much money medical providers should be paid by Medicare and health plans. Medicare, under the Reagan administration, initiated in 1985 the development of a new, fair and a more transparent fee schedule. This led to a large study, jointly conducted by researchers at [...]
Reference: http://www.cms.gov/MLNMattersArticles/downloads/MM7225.pdf HCPCS Code Amount HCPCS Code Amount HCPCS Code Amount HCPCS Code Amount A4565 $8.12 Q4013 $14.88 Q4026 $111.41 Q4039 $7.78 Q4001 $46.21 Q4014 $25.08 Q4027 $17.85 Q4040 $19.44 Q4002 $174.65 Q4015 $7.44 Q4028 $55.72 Q4041 $18.88 Q4003 $33.19 Q4016 $12.54 Q4029 $27.29 Q4042 $32.23 Q4004 $114.91 Q4017 $8.60 Q4030 $71.83 Q4043 $9.45 Q4005 [...]
On February 2, 2012, the state of California announced that it would apply short-term payment delays for Medi-Cal institutional providers due to a severe cash flow shortage. The effective date of the delays is March 1, 2012. Reimbursement to Medi-Cal institutional providers, except for clinics, designated public hospitals and local educational agencies, will be held [...]
The National Correct Coding Initiative (NCCI) – also known as CCI – was implemented to promote correct coding and to control improper coding leading to inappropriate payment. There are two NCCI code pair edit tables: Column 1/Column 2 Correct Coding Edit Table Mutually Exclusive Edit Codes (MEC) Edit Table …and another set of edits known [...]
The following post is to provide description to the indicators used on the Medicare Physician’s Fee Schedule. Multiple Procedure Indicator 0 = Criteria does not apply 1 = Standard multiple surgery criteria applies. Standard payment adjustment rules in effect before January 1, 1996, for multiple procedures apply. In the 1996 Medicare Physician’s Fee Schedule Indicator [...]
CMS issued an impact chart (Table 84 of the rule) which gives an overview of the RVU changes to the 2012 Medicare physician fee schedule by specialty. Table 84 does not show the impact of the -27.4 percent SGR (Sustainable Growth Rate) cut. Major policy changes with impacts displayed in the table are: The third year [...]
The compliance date for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding system (ICD-10-CM/PCS) is October 1, 2013. There are two parts to the ICD-10-CM/PCS: ICD-10-CM (Diagnosis Codes) – The diagnosis classification system developed by the by the Centers for Disease Control (CDC) and Prevention for us in all the U.S. [...]
California Medi-Cal providers recently received checks totaling $25.8 million as retroactive payment for claims processed between July 1, 2008 and August 18, 2008. In February 2008, a 10-percent Medi-Cal provider cut was proposed by the Schwarzenegger administration and agreed to by the state Legislature in an emergency budget session as part of efforts to address [...]
What are HSAs? Health Savings Accounts (HSAs) allow individuals to deposit pretax income into a savings account that can be used to pay for qualifying medical expenses — up to $3,050 for individuals and $6,150 for families in 2010. In return, enrollees have annual deductibles of $1,200 or more, with only certain types of care [...]
A 21.3% Medicare physician payment cut takes effect on June 1, unless Congress comes up with a solution. ACOG, the AMA, and other medical groups are pushing for a permanent fix through repeal of the flawed SGR formula for setting payment rates. But Members of Congress, many of them squeamish about increasing the federal deficit [...]
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