Category/ Medical Billing

Urgent Care Coding Updates 2022? Medicare Physician Fee Schedules

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Physicians are required to file their annual fee schedules with CMS (Centers for Medicare & Medicaid Services) by January 1st of each year. The physician fee schedule is used to determine the amount of reimbursement physicians receive for services provided to Medicare beneficiaries. In addition, the physician fee schedule is used as a reference point for determining the amount of payment made to physicians under the Medicare program.


To implement the Medicare Physician Fee Schedules, CMS has developed two separate systems: the Medicare Physician Fee Schedule (MPFS) and the Medicare Supplier Fee Schedule (MSF). The MPFS is a national system that applies to all providers of covered professional services, including hospitals, nursing homes, durable medical equipment suppliers, hospices, home health agencies, and certain other entities. The MSF is a regional system that applies to all non-hospital providers of covered professional services.


The Medicare Physician Fee Schedule is published annually in the Federal Register and includes information regarding the amounts payable to physicians for services rendered during the calendar year. In this article, we give you a quick overview of changes to the Medicare Physician Fee Schedule that will take place on January 1, 2022.


A summary of the Physician Final Rule for 2022

In November 2021, the Centers for Medicare & Medicaid Services (CMS) published the Medicare Physician Fee Schedule (MPFS) Final Rule. The Final Rule made further changes to the MPFS, which became effective on January 1, 2022.


Medicare reimbursement assumes-and physicians are expected to provide a full range of services and treatments that meet the needs of their patients. They are updated every year to reflect the most recent scientific evidence, changes in technology, and practice patterns. They are meant to improve quality healthcare, improve patient care, and help people get the care they need.


Medicare payment rates are updated annually based on inflation and other factors. They are subject to change on April 1 each year. More information about Medicare reimbursement can be found on the Centers for Medicare & Medicaid Services (CMS) website.


The RVUs are the relative values assigned to physician work. These values are determined by the Medicare Physician Advisory Committee, which is comprised of doctors and non-doctors with expertise in the field of health care. The RVUs attached to each service determine how much physicians earn from Medicare.


The geographic adjustment factor is based on the difference in costs of providing medical care between practice locations around the country. It can increase or decrease a physician’s Medicare payment, depending on whether the area they practice in has higher or lower practice costs than those nationwide.


Expanded Data Reporting (EDR) 10C and EDR 11C provide physicians with a single report containing their actual Medicare payments, as well as their RVUs, GPCI, adjustments, and other important information needed to submit appeals effectively.

These are the national allowable, calculated based on RVUs:

Two percent Medicare cuts will also affect final payments because Congress won’t be able to stop the cuts. Lab tests, for example, are not part of the physician fee schedule, so these rates will not be affected.


Vaccine Administration

As of 2021, the cost of influenza, pneumococcal, and hepatitis B virus vaccines will increase to $30 from $17.63 on average. G0008 (influenza), G0009 (pneumococcal), and G0010 (hepatitis B) are included here. Geographic adjustments may apply.


As of January 1, the year following the end of the Public Health Emergency (PHE), COVID-19 vaccine administration and monoclonal antibody infusion services will remain at the current rates. Unless and until another extension is made, the PHE will remain in effect until January 16, 2022.


Split/Shared Services

Services that are split or shared depending on the fact sheet from the doctor and the non-physician practitioner (NPP) that was given on the date of service.

Incident-to guidelines must be followed in the office. Shared visits will be restricted to institutional settings starting in 2022.


Telehealth’s new POS

Telehealth services are now available through a new POS added by the Centers for Medicare & Medicaid Services (CMS). With the new POS 10, telehealth services are delivered to the patient’s home. POS 02: Telehealth services that are not provided in the patient’s home are also listed as POS 02. Effective April 1, 2022, this new POS will be available for use.


During the COVID-19 PHE, CMS will cover telehealth services until the end of 2023 while they continue to look at changes to the permanent policy. Practices that use load sharing will see their originating site fee, Q3014, go up a little in 2022. It will go from $27.02 to $27.59.


Physician Assistants

As part of the evolving role of non-physician practitioners (NPPs), CMS will be able to make direct payments to physician assistants (PAs). Payments are only available to the PA’s employer at the moment. Beginning January 1, 2022, PAs will be able to bill Medicare directly for professional services or integrate with other PAs and bill Medicare for PA services.


Addition of Modifier 93

On January 1, 2022, a new modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) became effective. With this modifier, physicians or other healthcare professionals can report on medical services provided through audio-only communication with patients. As the name implies, synchronous telemedicine consists of a real-time, two-way conversation between a physician or other qualified healthcare provider and a patient located far from the physician. This modifier is intended for payers that prefer E/M codes instead of the time-based CPT codes 99441–99443 for billing calls.


COVID-19 Immunization Diagnosis Codes

Three new diagnosis codes were announced by CMS for April 2022, including two codes for COVID-19 vaccination status. Coding for inpatient reimbursement has primarily been designed for hospital use. A hospital’s reimbursement is based on the most frequently used resources during a diagnosis.


Z28.310 – Covid-19 unvaccinated (To be assigned to patients who have not received one or more doses of the Covid-19 vaccine)


Z28.311 – COVID-19 partially vaccinated (Assignation when the patient has received at least one dose of the multidose COVID-19 vaccine regimen but not the entire regimen)


Z28.39 – Another under-immunization status


New Code Update: 99211 Consistency Adjustment

This code descriptor will be used as of 2022, describing office or other outpatient visits for evaluating and managing established patients that do not require the presence of a physician or provider of health care. 99211 requires that these services be medically necessary (i.e., clinically indicated) and accompanied by a plan of care by a physician or other qualified healthcare professional.

As a leading revenue cycle management company, Scribe Align LLC provides a variety of medical billing services. We can assist you with billing and coding for urgent care services.

Differences between Physician Billing and Hospital Billing

Physician Billing vs. Hospital Billing: Understanding the Key Differences


Physician billing and hospital billing are the two types of medical billing that prevail in the healthcare industry. But what is the difference between hospital billing and physician billing?
This post will cover some essential points regarding the difference between physician billing and hospital billing, which will help you understand what factors come into play while learning about these two types of healthcare claims.


With physician billing and hospital billing, there are specific differences to tackle. For instance, physician billing is based on the percentage of the remuneration earned through procedures or a price for different services rendered. As for hospital billing, its based on the pricier reimbursement model, where the hospital charges the patients insurance plan for the services required and received.


Professional billing relates to physician billing, and institutional billing refers to hospital billing. In the healthcare industry, professionals differentiate between these terms depending on the purpose of the billing process and the services involved. The two methods, however, fall under the general medical billing process.


To highlight the key differences between physician and hospital billing, lets find out how they are used in both cases.


Physician billing: What is it?

Physician billing, or professional billing, refers to the billing process. Where claims submitted by physicians and healthcare providers are reimbursed when performing medical services or procedures on patients covered by insurance, once you decide to become a physician billing service provider, you must help the physicians or healthcare providers with claim submission and other related billing and collection tasks.

CMS-1500 or 837-P is the claim form used for physician billing. The only difference between these forms is that the CMS-1500 is a paper document, and the 837-P is an electronic document.
•    Some insurance companies, like Medicaid, Medicare, and others, only accept electronic claims as payment methods. P stands for professional configuration on the 837-P claim form, an electronic version of CMS-1500. Most of the time, expert physician billing services have more to do than institutional or hospital billing services.
Billing a doctor is an important administrative task that controls many other tasks in a medical office, like making appointments, greeting patients, registering patients, and collecting payments. 
To make sure that the organizations overall financial and operational goals are met, people who work in medical billing and coding need to know a lot about the policies and practices of physician billing. Because physicians bill insurance companies directly for patient services, a medical offices billing department relies on the accuracy of coding and claims processing to ensure that payments are made promptly. 
The organizations ability to stay in business depends on how much money it gets for each service it provides. Medical professionals can improve their ability to collect payments by learning the basics of physician billing.
•    Both inpatient and outpatient services can be billed under physician billing; both types can only be billed after patient verification.
•    All outpatient and inpatient services will be billed based on the patients insurance policy, so its important to check.
•    It is important to keep in mind that physician billing includes medical billing and medical coding as well.
Therefore, medical billers need to learn both billing and coding procedures. Healthcare professionals offices and hospitals employ medical billing and coding teams to handle everyday billing.
The process of physician billing is complicated and detailed. It is also time-consuming and requires a lot of effort and time. Scribe Align makes it easy by connecting healthcare providers with hospitals and insurance companies so they can focus on patient care instead of insurance claim submission. By outsourcing the billing process to a healthcare billing service provider like Scribe Align, you can focus on the doctors practice and patient care instead of worrying about getting paid for the medical services.

Hospital billing: What is it?

•    The hospital or healthcare provider submits claims for inpatient and outpatient services in hospital billing. For the same reason, hospital billing can also refer to institutional billing.
•    A hospital billing system also accounts for the services provided by skilled nurses. They also bill claims for medical facilities and medical claims for laboratory services, medical equipment, radiology, supplies, etc.
•    An institutions configuration is indicated by I. Hospital billing is performed using forms UB-04 or 837-I. In contrast, the UB-04 is a paper-based form, while the 837-I is a computer-based form.
•    A physicians billing is similar to a hospitals billing, except that hospital billing only deals with the medical billing process; it does not deal with medical coding. However, physician billing also includes medical coding.
•    The hospitals appointed medical biller is only responsible for billing and collection in hospitals. It is challenging to handle hospital billing as compared with physician billing.


Billing for Physicians and Hospitals: how to increase revenue?

•    Hospitals and physicians have different billing models when it comes to revenue reimbursements. But their processes have a significant impact on preventing denials and fraud.
•    Keeping track of unbilled and unmissed claims and services becomes the physician billers priority. However, the staff should be aware of any billing or coding errors when submitting claims. Technical errors can also cause mistakes for various reasons.
•    Outsourcing healthcare billing and coding services is often the best option for hospitals and healthcare providers to avoid errors and payment losses.
•    The hospital billing process is quite different from physician billing. A hospital or institutions billing function includes collection and billing.
•    As a result, institutional cases are handled only by coding experts because hospital coding is considered more complex than physician coding.

It is essential to avoid violating HIPAA privacy and security rules since physicians and hospital billing staff have access to private and confidential patient health information.
Thank you for reading about Physician Billing and Hospital billing. I am pleased to provide you with information on physician and hospital billing.

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