Understanding the Perils of the 60-Day Refund Rule

Published: Tue, 07/30/24

Updated: Sun, 08/04/24

Link to all things medical coding & billing

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...

2024 Coding Clinic 2nd Quarter: COPD and Z79

COPD is an overarching term for conditions which cause difficulty breathing, specifically from some type of impediment to air movement. The two main types are emphysema and chronic bronchitis. Both types can be present in the same patient. The most common etiology is tobacco exposure. It is a chronic, irreversible condition, although steps can be taken...

A 'TsunamAI' Of Change Is Coming To Healthcare

In the last 50 years, there have been significant developments that have forever improved the delivery of healthcare. Consider imaging (MRI/CT scans), minimally invasive surgery, anti-viral therapies, precision medicine (e.g., CRISPR and gene editing) and near or complete eradication of diseases like polio and smallpox. As we look back 50 years from...

FY 2025 ICD-10-PCS: New Technology Code for Bioengineered Human Acellular Vessel

Current treatment for traumatic arterial injury of the extremities consists primarily of replacement with autologous venous or synthetic graft. However, the need for emergent repair or the unsuitability of a patient’s veins makes harvesting an autologous graft less than ideal and synthetic grafts have a higher...

Remote monitoring code changes could make it into CY2026 fee schedule, at the earliest

The American Medical Association’s coding panel, which is responsible for creating medical billing codes, is set to meet September 19-21 in Albuquerque where it will consider yet another proposal to lower the requirements for providers to get paid for remote monitoring. Remote monitoring was scarcely mentioned in the CMS proposed...

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...

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