CMS proposes new payments for digital health under CY2025 PFS draft rule

Published: Wed, 07/17/24

Updated: Wed, 07/17/24

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CMS proposes new payments for digital health under CY2025 PFS draft rule

The Centers for Medicare & Medicaid Services' proposed calendar year 2025 physician fee schedule rule, out Wednesday, proposed an assortment of new payments and coverage for digital health services, including digital therapeutics, telehealth and audio-only telehealth services. It did not, however, address the bulk of Medicare telehealth waivers expiring at...

CMS Rolls Out Largest-Ever Navigator PPACA Enrollment Grant Offering

An unprecedented number of individuals are now enrolled in Patient Protection and Affordable Care Act Marketplace health insurance plans – and federal officials this week signaled that the trend can likely be expected to continue. The Centers for Medicare & Medicaid Services (CMS) recently announced the availability of half a billion dollars in grants over...

Release of 2025 OPPS Proposed Rule: Focuses on Payment Adjustments, Health Equity, and Maternal Health

While CMS (the Centers for Medicare & Medicaid Services) usually releases new rules in the afternoon, on July 10 they chose to release the 2025 Outpatient Prospective Payment System (OPPS) Proposed Rule before 9 a.m. At 984 pages, the rule contains the usual adjustments to payment rates for both hospital outpatient services and ambulatory surgery center...

8 keys to improve revenue cycle management in your practice

Sea Chen, MD, PhD, remembers when his practice’s business office failed to notify others in the clinic about some denied claims and the reasons behind them. “Because of this, we had a bunch of digging to do before we found our problem,” said Dr. Chen, the AMA’s physician director for practice sustainability. The practice could have avoided this scenario if it...

Here's why a proposal for prior authorization CPT codes returned to the drawing board

A recent proposal to report prior authorization to insurance plans through CPT codes was withdrawn at the eleventh hour when its physician advocate made an unexpected discovery: For certain codes and in very narrow circumstances, the prior authorization requirements were already in place...

IPPS: Planning for the Second Half of 2024

As we begin the second half of the year, it is a convenient time to make plans and take stock of our coding operations. There will be much to do when the Inpatient Prospective Payment System (IPPS) Final Rule is released. For example...

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