by RCM STI | Nov 13, 2024 | RCM Newsletter
CMS CY 2025 Physician Fee Schedule Final Rule Reminder CMS finalized a 2025 PFS Conversion Factor (CF) of $32.3465. The CY 2024 conversion factor is $33.29, the CY 2025 Conversion Factor will result in a decrease of 2.8% or $0.93. To make this information more...
by RCM STI | Oct 23, 2024 | RCM Newsletter
Influenza Vaccine: CMS Holding Claims for CPT Code 90658 From CMS: CMS is aware of an issue affecting payment for CPT code 90658: Long descriptor: Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use Short descriptor: IIV3...
by RCM STI | Sep 23, 2024 | RCM Newsletter
Annual Flu Vaccine Pricing from CMS From CMS: Part B payment allowance limits for seasonal influenza (flu) vaccines (that is, the vaccine product) are 95% of the Average Wholesale Price (AWP). In hospital outpatient departments, payment is based on reasonable...
by RCM STI | Aug 21, 2024 | RCM Newsletter
Medicare Physician Fee Schedule Proposed Rule for CY 2025 The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), proposed new policies in the calendar year (CY) 2025 Medicare Physician Fee Schedule (PFS)...
by RCM STI | Jul 21, 2024 | RCM Newsletter
CMS to Close Program that Addressed Medicare Funding Issues Resulting from Change Healthcare Cyber-Attack On June 17, 2024, CMS announced that payments under the Accelerated and Advance Payment Program for the Change Healthcare/Optum Payment Disruption (CHOPD) will...
by RCM STI | Jun 21, 2024 | RCM Newsletter
CPT 99459 Pelvic Examination Billing for Medicare CPT 99459 was added to CPT coding for 2024 as an add-on code service, which means that this code is only payable if provided and billed on the same day, on the same claim, as the appropriate service(s) allowed per...
by RCM STI | May 21, 2024 | RCM Newsletter
New Codes for Covid-19 Monoclonal Antibody On March 22, 2024, the FDA released an emergency use authorization for the PEMGARDA monoclonal antibody product for pre-exposure prophylaxis of COVID-19. New Product Code – Q0224 Administration Code – M0224 Click here for...
by RCM STI | Apr 21, 2024 | RCM Newsletter
Waystar Clearinghouse STI RCM is transitioning all Practice Manager based clients from Change Healthcare to Waystar clearinghouse. Make note during this transition, we are still actively sending claims to payers as we have, until set up and the enrollments are...
by RCM STI | Mar 21, 2024 | RCM Newsletter
CMS Suspends Appropriate Use Criteria for Advanced Diagnostic Imaging (AUC) Program CMS recently released a transmittal for Medicare Administrative Contractors (MACs) to put into place the agency’s suspension of the Appropriate Use Criteria for Advanced...
by RCM STI | Feb 21, 2024 | RCM Newsletter
Excellus BCBS Updated NDC/HCPCS Codes When Billing for Depo-Provera® Effective February 15, 2024, providers can bill J1050 or J3490 for Depo-Provera injections for all lines of business. For all lines of business*, effective February 15, 2024, please submit all claims...
