Medicare is one of the most common healthcare plans that the US population is a part of. Most of the healthcare providers want to enroll in the Medicare panel to ensure that they reach out to maximum number of patients. With around 44 million people all over United States enrolled in the Medicare program, it is important for the healthcare organizations and individual practitioners to stay up to date with the changes occurring for billing in healthcare.

This article will take you through some crucial changes reported in the Medicare plan in the last few months. Make sure you keep them in mind to stay compliant with the rules and get easy reimbursements. But before delving into the plans, let’s know about some basics on Medicare and how they are applicable to billing in healthcare.

What is Medicare for billing in healthcare?

Medicare is a crucial health insurance program issued and maintained by the federal government. The management and implementation is mainly looked after by the Centers for Medicare and Medicaid Services (CMS). Any person who is 65 years old or above can have themselves enrolled in the program. People above 18 years can also be a part of the program if they have a special case of disability or end stage renal disease.

Over all, the program is very important for the billing process in healthcare since the billing team has to be up to date with the services covered under the umbrella plan. Only with the proper implementation of the billing procedure, the physicians will get reimbursed on time and the organization will have a smooth cash flow.

What are the different parts of the Medicare Plan used for billing in healthcare?

The Medicare plan is mainly segmented into 4 parts and designated as A, B, C and D. Each one of the plans has different coverage points. Here are the lists of the services covered:

Medicare Part A:

  • This is part of the hospital coverage plan.
  • It covers in-patient hospital visits and stays as well as skilled nursing facilities.
  • It also includes some home health care facilities.

Medicare Part B:

  • This is part of the medical coverage plan.
  • It covers most doctor visits, out-patient visits and other out-patient services.
  • Among the services, it includes the X-rays, laboratory testing and preventative screenings.
  • Medicare Part A and B together join to form the “Original Medicare”.

Medicare Part C:

  • This is offered by the private insurance companies.
  • They cover all the services that are offered by the Original Medicare.
  • However, they can also offer additional benefits.
  • This part is commonly known as the Medicare Advantage Plan.

Medicare Part D:

  • This part is dedicated to the prescription drugs.
  • The patients can avail these services only from the private insurance payers.
  • In some cases, this part is included in the Medicare Advantage Plan.

What are the latest Medicare changes for billing in healthcare?

Here are some latest guidelines that your billers should know to make sure that you are not missing out on any revenue.

1.Repayment of money received from Medicare during Covid-19 emergency:

  • Providers and suppliers who had received the Covid-19 Accelerated and Advanced Payments (CAAPs) from the Government during the public health emergency have to repay the money.
  • The repayment window will open after a year of receiving the designated funds.
  • The providers will get the claims adjusted by 25% within 11 months and by 50% within the next 6 months. The adjustment will be done by the CMS.
  • If the amount is still due after this window, the providers will receive a letter from the Medicare contractor regarding the same. The providers will have to pay the due amount within 30 days of issuance of this letter.
  • In case the providers fail to pay within the mentioned time frame, an interest rate of 4% will be charged hereafter.

2.Limited subsequent nursing facility care services in telehealth:

  • There has been a change in the number of telehealth visits for the patient’s admitting provider.
  • The provider can be a physician or the non-physician practitioner. However, it is not applicable for consulting providers.
  • Now it has been limited to one visit per 14 days. Earlier, it used be one visit per 30 days.
  • The changed rule is applicable to CPT codes: 99307, 99308, 99309 and 99310. They must be billed with appropriate GT or GQ modifiers.
  • It can also be coupled with place of service code 02.
  • The date of service must be on or after 1st January, 2021 and the Medicare bills must be processed on or after 6th July, 2021.

3.Medicare payment for home infusion therapy (HIT):

  • With effect from 1st January 2021, Medicare will make suitable payments to the qualified Home Infusion suppliers.
  • They must be assisted with suitable HCPCS Level II codes: G0068, G0069, G0070, G0088, G0089 and G0090.
  • They can also be reported with J codes, which will help in determining the payments and payment categories.
  • In case “Not Otherwise Classified” (NOC) codes J7799 – J7999 are used, the contractors will determine the payments.
  • When the NOC code is used, the biller will have to identify the corresponding drug name in the comment section of the professional service claim. This should be in correspondence with the HIT G code.

4.Ambulatory Surgical Center (ASC) Payment System Update:

  • Effective from 1st April, 2021, the CPT code 0632T is now linked again to the payment indicator J8 for Ambulatory Surgical Center.
  • This code has been reassigned in an adjusted rate.
  • Medicare plan now also covers the clinical study of the Therapeutic Intra-Vascular Ultrasound System (TIVUS).
  • The study mainly focuses on the patients with pulmonary arterial hypertension. The area of study is the pulmonary artery denervation in such individuals.
  • In case of other ASC payments from 1st January, 2021 onwards, professionals of billing in healthcare must look out for new HCPCS Level II codes.
  • There also have been certain crucial changes to the drugs used in ASC with respect to the dosage descriptors. The billers must note these changes to stay updated in the revenue cycle process.

That was all about the latest Medicare changes that you must look out for billing in healthcare. The revenue cycle management is an evolving process. Latest modifications should be studied and implemented to get the maximum benefits.

Hope this blog helped you understand the Medicare changes that took place in April 2021. For any queries, write them below and we will get back to you if they are relevant. To know more on such topics, subscribe to our blog. Follow us on Facebook, Instagram, Twitter and LinkedIn to get regular updates.