CMS OPPS Proposed Ruling Focuses on Social Drivers in Outpatient Settings

Published: Wed, 08/28/24

Updated: Wed, 08/28/24

Link to all things medical coding & billing

CMS OPPS Proposed Ruling Focuses on Social Drivers in Outpatient Settings

Today I would like to elaborate on recent remarks from Colleen Ejak regarding the 2025 Outpatient Prospective Payment System (OPPS) Proposed Rule regarding quality metrics and the inclusion of the social determinants of health (SDoH). The Centers for Medicare & Medicaid Services (CMS) is expanding its SDoH initiatives for quality reporting from the...

CMS reports over 12,000 No Surprises Act violations

The Centers for Medicaid and Medicare Services this week released a report on complaints and enforcement efforts concerning the Public Health Service Act, which includes the No Surprises Act.

As of June 30, CMS received more than 16,073 complaints. Of these, 12,077 were No Surprises Act complaints, with 1,777 being alleged violations...

Codes G2211 and GIDXX – Continued Uncertainty

If you have been listening to the discussions on Monitor Monday and Talk Ten Tuesday about the use of the new HCPCS code G2211, you know there remains some uncertainty on its use. Several weeks ago, the Centers for Medicare & Medicaid Services (CMS) stated that they would be releasing a FAQ document the next week. Well, that period came...

Leveraging Generative and Advanced AI to Transform Coding and CDI – Part 1

In recent years, generative artificial intelligence (GenAI) has passed medical exams, diagnosed complex cases, and even come up with ways to combat a pandemic. In fact, large language models (LLMs) such as GPT-4, Google’s BARD, and BioGPT now perform complex tasks that can completely transform clinical...

Proposed new Medicare billing codes could boost digital mental health treatment

The proposed new Medicare billing codes in the proposed Physician Fee Schedule (PFS) for 2025 include three specific codes for digital mental health treatment (DMHT) relating to professional services involving DMHT devices. This is the first time CMS has proposed Medicare reimbursable codes specific to digital therapeutic products through the physician...

Understanding the Perils of the 60-Day Refund Rule

The 60-day Refund Rule, created by the 2010 Patient Protection and Affordable Care Act (PPACA), requires providers to report and return Medicare and Medicaid overpayments within 60 days of identifying them. Failure to comply with the 60-day Refund Rule can result in the imposition of a civil monetary penalty under 42 C.F.R. §1003.210(a)(8), with a maximum...

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