Billing and reimbursement

Q: For calendar year 2021, what is the inpatient deductible for Medicare beneficiaries' hospital inpatient lifetime reserve days (LRD)?

The 2021 OPPS final rule, released December 2, doesn’t pack many surprises, with CMS generally finalizing most policies as proposed or choosing to continue with current policies. This should aid hospitals required to implement many of its policies in just a few short weeks due to the pandemic-disrupted rulemaking cycle.

CMS announced on November 25 that it is building on the flexibilities granted by the Hospitals Without Walls program to launch the Acute Hospital Care at Home program. Under this program, eligible hospitals will be allowed to treat certain inpatients in the patient’s home.

Modifiers provide a means by which a physician or facility can flag a service that has been altered by a special circumstance but has not changed in definition or code. Break down CPT guidelines for reporting hospital modifiers -25, -50, -59, -LT, and RT.

CMS on November 20 released MLN Matters 12049, which clarifies the effective date and appropriate use of two new National Uniform Billing Committee (NUBC) condition codes.

CMS finalized the long-awaited Stark Law final rule on November 20. The final rule includes significant changes to exceptions to the law as well as expanded guidance and clarification.

CMS recently announced coding and payment information for the administration of the COVID-19 monoclonal antibody product, bamlanivimab.

Q: How much will Medicare pay for FDA-approved or emergency use authorized COVID-19 vaccines?

The Office of Inspector General (OIG) is planning to audit hospital inpatient claims for compliance with the 2-midnight rule, according to a recent update to its Work Plan.

Review 2021 ICD-10-CM codes for behavioral health diagnoses and a breakdown of CPT guidelines for psychiatric diagnostic evaluations.