CMS Proposes Payment Models for Surgical Procedures

Published: Tue, 06/04/24

Updated: Tue, 06/04/24

Link to all things medical coding & billing

CMS Proposes Payment Models for Surgical Procedures

The Centers for Medicare & Medicaid Services (CMS) has proposed an episodic payment model, the Transforming Episode Accountability Model (TEAM). This is one of CMS’s “innovation” models. If it makes it through the rule making process, the proposed model would launch on Jan. 1, 2026 and run for five years, ending on Dec. 31, 2030.

Provider compensation rises again as groups push productivity

Provider compensation is still on the rise after the COVID-19 pandemic, according to the latest data from the Medical Group Management Association (MGMA). For the fourth consecutive year, MGMA recorded increases in provider compensation among primary care and nonsurgical specialty physicians in 2023. Primary care physicians saw the largest...

CMS OMH Marks Women’s Health Week with A Call to Action

Federal officials are marking National Women’s Health Week with a call for awareness and reform to address stubborn disparities that have lingered historically – and to this day lead to poorer medical outcomes. The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) noted that the week-long event begins on Mother’s Day each year, followed by comprehensive efforts to...

Why private practices need a stronger handle on the revenue cycle

A physician private practice with a good handle on its revenue cycle can bring in more dollars and adapt more quickly to external forces such as lower payment rates. It can also increase patient satisfaction “because of different transparencies that you can pass on to your patients. Their bills and statements may be clearer if you review the revenue cycle and optimize it,” said Sea Chen, MD...

Understanding Billing Requirements for Caregiver Training Services

As part of the Jan. 1, 2024 Outpatient Prospective Payment System (OPPS) guidelines, caregiver training services (CTS) codes were listed as billable services if provided by physicians and non-physician practitioners (NPPs). I thought I would revisit these codes with greater specificity, as I am seeing some questions come up related to lack of provider...

Consideration postponed for new billing codes for prior authorization

Medical experts have put on hold a proposal to create new billing codes for prior authorizations. The American Medical Association’s CPT (current procedural terminology) Editorial Panel was scheduled to meet May 9 to 11. The agenda included a proposal to create new codes that physicians could use to bill for time spent requesting approval to treat patients.

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