Billing and reimbursement

Q: What are the penalties for failure to meet the provider-based rules?

CMS proposed a test this week for a new Medicare Part B prescription drug plan that would replace its previous policy of paying physicians and outpatient hospital departments the average sales price (ASP) plus 6%.

CMS will require revenue code and HCPCS code reporting for rural health clinics starting April 1. CMS created more questions than answers during the recent Rural Health Open Door Forum call and in the guidance published in the last few months. This article will help sort through the issue.

This week’s note is about new rural health clinic billing requirements. 

This week’s updates include coding revisions to NCDs; the April 2016 hospital OPPS update; and more!

Q. How is CMS made aware of the fact that a hospital is operating a provider-based department?

Our experts answer questions about Composite APCs, modifier –CT, and more.

This month's column is all about data--the importance of providers reporting accurate and complete data, as well as CMS having complete, accurate, and consistent data to compute future payment rates.

The CPT Manual divides drug administration services into three different categories:

• Hydration (CPT codes 96360-96361)
• Therapeutic, prophylactic, and diagnostic injections and infusions (96365-96379)
• Chemotherapy and other highly complex drug or highly complex biologic agent administration (96401-96549)

The 2016 CPT® code update may have been relatively small compared to previous years, but the urinary and genital system sections did receive numerous changes to align them with other sections of the code book.