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Comments on Proposed Rules for Payment Systems and Medicare Physician Fee Schedule due October 5 In August, CMS published the calendar year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule and the Medicare Physician Fee Schedule Proposed Rule. The deadline for comments on both rules is October 5, 2020. ISASS will submit comments on both rules by the deadline, but for individual members and practices interested in submitting comments, please see links below to submit comments. You can read the ISASS summary of the Medicare Physician Fee Schedule Proposed Rule Here. To submit comments on the Medicare Physician Fee Schedule Proposed Rule, click here: Comment Here You can read the ISASS […]

CMS Issues Proposed Rule for 2021 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System On August 4, 2020, the Centers for Medicare & Medicaid Services (CMS) published the calendar year (CY) 2021 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Proposed Rule. Among notable changes, CMS proposes to pay the average sales price (ASP) minus 28.7 percent for 340B drugs; change the expansion exception process for a subset of physician-owned hospitals; expand the prior authorization process to include two new categories of services reimbursed under the OPPS; and eliminate the inpatient only list. Proposed Hospital Outpatient Department and ASC Payment Updates CMS proposes an increase of 2.6% for OPPS payment rates in CY […]

CMS Expands COVID-19 Telehealth Provisions to Skilled Nursing Facility Residents The current COVID-19 public health emergency does not waive any requirements related to Skilled Nursing Facility (SNF) Consolidated Billing (CB); however, the Centers for Medicare & Medicaid Services added CPT codes 99441, 99442, and 99443 to the list of telehealth codes coverable under the waiver during the COVID-19 public health emergency. These codes designate three different time increments of telephone evaluation and management service provided by a physician. You can bill for these physician services separately under Part B when furnished to a SNF’s Part A resident. Medicare Administrative Contractors (MACs) will reprocess claims for CPT codes 99441, 99442 and 99443 with dates of service on or after March 1, 2020, that were […]

CMS Publishes Final Rule for Inpatient Prospective Payment System On September 2, 2020, CMS issued the fiscal year (FY) 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) final rule, which includes important provisions designed to ensure access to potentially life-saving diagnostics and therapies for hospitalized Medicare beneficiaries. The changes will affect approximately 3,200 acute care hospitals and approximately 360 Long-Term Care Hospitals (LTCHs). CMS estimates that total Medicare spending on acute care inpatient hospital services will increase by about $3.5 billion in FY 2021, or 2.7%. In the final rule, CMS approved a record number of 24 new technology add-on payments (NTAP), which is an additional payment to hospitals for cases involving eligible new […]