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Medical billing, coding, denials, credentialing, PCMH and practice operations, written to be useful on Monday morning.
After the Election: Five Health Policy Items Practices Are Watching Now
The November 5 election is over and the practical questions for practices are the ones that were pending before it: the December 31 telehealth expiration, the 2.83% Medicare cut, ACA subsidy timing, Medicare Advantage disruption during open enrollment, and cybersecurity rules. Here is what is decided and what is not.
ICD-10-CM FY2025 Takes Effect Today: 252 New Codes and First-Week Checks
The FY2025 ICD-10-CM update is live for dates of service from October 1, 2024: 252 new codes, 36 deletions and 13 revisions. Here are the additions primary care and specialty practices will actually use, the deletions that cause rejections, a worked example, and a first-week checklist.
CY2025 Physician Fee Schedule Proposed Rule: What the 2.8% Cut Means
CMS released the CY2025 Physician Fee Schedule proposed rule on July 10: a conversion factor of $32.36, down 2.8% from $33.29, new Advanced Primary Care Management codes, and telehealth proposals that depend partly on Congress. Here is what changes, who it affects and how to model it on your own code mix.
The 2025 Medicare Advantage Rate Announcement: What It Means for Practices
CMS finalized 2025 Medicare Advantage payment rates on April 1, 2024, with a 3.7 percent average increase and the second year of the new risk adjustment model. Plans call it a cut. Here is what actually changed, how it reaches your practice through documentation requests and contract terms, and what to watch for.
Change Healthcare Is Down: What We Know on Day Three and What to Do Now
Since February 21, 2024, Change Healthcare has disconnected its systems after a cyberattack, taking claims, eligibility, remittance and pharmacy transactions offline for a large share of U.S. practices. Here is what has been confirmed, what has not, and the first steps to protect cash flow.
The 2024 Fee Schedule Final Rule: What Practices Must Change Before January 1
CMS issued the CY 2024 Physician Fee Schedule final rule on November 2, 2023. The conversion factor falls 3.4% to $32.74, G2211 becomes payable, the MIPS threshold stays at 75 points, and caregiver training codes are covered. Here is the practice-level checklist for the eight weeks before it takes effect.
Medicare Advantage Now Covers a Majority: Preparing Your Practice for January
Medicare open enrollment runs October 15 to December 7, 2023. KFF reports that 30.8 million people, 51% of eligible beneficiaries, are in Medicare Advantage this year. Here is what plan switching does to a practice in January, what the CMS-4201-F prior authorization rules change on January 1, and how to prepare now.
CMS Proposes the 2024 Fee Schedule: G2211 Arrives, the Conversion Factor Falls
CMS released the CY 2024 Physician Fee Schedule proposed rule on July 13, 2023. It would cut the conversion factor by about 3.3% and finally pay for the G2211 visit complexity add-on. Here is what changes for independent practices and what to do before comments close on September 11.
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