Billing and reimbursement

The American Medical Association (AMA) on November 10 announced a handful of new CPT codes for reporting COVID-19 vaccine products and immunization administration.

The two new FAQs address billing for monoclonal antibody treatments provided in the hospital outpatient setting.

Debbie Jones, CPC, CCA, details ICD-10-CM coding for strabismus and CPT coding for surgical treatments used to correct eye misalignment.

A formal CDI program can address many of the challenges home health agencies face, but knowing how to start one isn’t easy. Consider these tips to create a focused home health CDI program.

CMS’ guidance on the use of modifier -CS may create as many questions as it answers. Learn how to navigate lingering questions and avoid pitfalls.

Q: For the purposes of determining a Medicare overpayment, should claims that we are uncertain whether they were appropriate be included? Is this defined under the False Claims Act (FCA)?

CMS’ Fourth COVID-19 Interim Final Rule with Comment Period includes additional payment for new COVID-19 treatments, price transparency requirements for COVID-19 diagnostic tests, and coverage for potential vaccines among other provisions.

Valerie A. Rinkle, MPA, CHRI, writes about Medicare guidance on and updated payment policies for COVID-19 testing, vaccines, and telehealth services.

Q: How does case-mix index (CMI) impact hospital finances? What should revenue integrity staff look for when conducting CMI analyses?

The full U.S Court of Appeals declined to reconsider two recent decisions that upheld CMS’ cuts to reimbursement for certain off-campus provider-based department (PBD) visits and drugs acquired under the 340B program, the American Hospital Association (AHA) announced October 19.