Kenneth Milgraum’s Post

Medicare Claims Processing Manual Update: Gap-Filling DMEPOS Fees Learn about revisions to the manual (PDF), including 2024 update factors. CR 13617 updates the gap-filling DMEPOS fees to include update factors for gap-filling purposes. CMS uses gap-filling in establishing fee schedule amounts for new DMEPOS items or services that don’t have a fee schedule pricing history. Note: When gap-filling for capped rental items, it’s necessary to first gap-fill the purchase price and then compute the base period fee schedule at 10% of the base period purchase price. For used equipment, we establish fee schedule amounts at 75% of the fee schedule amount for new equipment. Gap-filling isn’t used in establishing fee schedule amounts for new lymphedema compression treatment items that don’t have a fee schedule pricing history. Information on payment for lymphedema compression treatment items is available in Section 181.1, Medicare Claims https://lnkd.in/gTmWvnVM

Medicare Claims Processing Manual Update: Gap-Filling DMEPOS Fees Learn about revisions to the manual (PDF), including 2024 update factors. CR 13617 updates the gap-filling DMEPOS fees to include update factors for gap-filling purposes. CMS uses gap-filling in establishing fee schedule amounts for new DMEPOS items or services that don’t have a fee schedule pricing history. Note: When gap-filling for capped rental items, it’s necessary to first gap-fill the purchase price and then compute the base period fee schedule at 10% of the base period purchase price. For used equipment, we establish fee schedule amounts at 75% of the fee schedule amount for new equipment. Gap-filling isn’t used in establishing fee schedule amounts for new lymphedema compression treatment items that don’t have a fee schedule pricing history. Information on payment for lymphedema compression treatment items is available in Section 181.1, Medicare Claims https://lnkd.in/gN-F2NyU

Want to know more about Medicare, Billings, A1, A2 & A7 Rates, Bulk Billing, Mixed Billing and Private Billing? Find out here: https://lnkd.in/gmR_C7jc #peoplemedical #doctor #internationalmedicalgraduates #IMG #GP #generalpractice #generalpractitioner #Medicare #Billing

⚠️ Spring Budget: NIC cuts, no GP funding Specialist medical accountants have raised concerns that the viability of GP practices is at risk, following the failure to allocate necessary funding during this week’s Spring Budget. While we can find some solace in further National Insurance cuts, we are deeply concerned about the impact this has had on our practices. The absence of any effort to even match inflation is both alarming and disheartening, particularly considering we are on the cusp of an election. Under normal circumstances, we would anticipate the government to be making every effort to address the GP funding crisis. Moreover, with accountants acknowledging the necessity for practices to optimise the us e of ARRS funding, this recent news casts a shadow over the expectation that practices will employ GP locums at comparable levels to those in 2023. This situation amplifies the need for increased pressure on the Government to permit the money allocated to ARRS funding to be utilised in a manner that practices deem most effective and efficient. Thanks for watching. For more insights , visit the NASGP website now and  look out for your email digest on Monday. https://lnkd.in/eFANvZb3

CMS' proposed changes to the No Surprises Act: This week I’m diving into how CMS proposes to improve negotiations between providers and payers.     A lot more information would have to be provided to the gov't by all parties to the negotiations, but CMS' ultimate goal here is to have accurate and timely information about the claim that will expedite the process.     Can the changes in CMS’ proposed rule actually accomplish that? Check out my blog to read the latest and let me know your thoughts.  https://lnkd.in/eV3xZwB3

Many of you have heard about the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process. CMS originally expected about 17,000 claims would be submitted through the IDR portal every year, but a recent analysis found that 14 times that amount were submitted.     To resolve problems associated with this enormous underestimation, CMS recently proposed changes. My latest blog – the first in a series of three on the topic– dives into this new proposed rule and explains what both payers and providers should expect.     First up: The IDR registry. Take a look and let me know your thoughts. Do you think a federally mandated IDR registry will help solve some of the main concerns raised with the IDR process?     https://lnkd.in/eXtcakMk 

Many of you have heard about the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process. CMS originally expected about 17,000 claims would be submitted through the IDR portal every year, but a recent analysis found that 14 times that amount were submitted. To resolve problems associated with this enormous underestimation, CMS recently proposed changes. Zelis' latest blog – the first in a series of three on the topic – dives into this new proposed rule and explains what both payers and providers should expect. First up: The IDR registry. Take a look and let us know your thoughts. Do you think a federally mandated IDR registry will help solve some of the main concerns raised with the IDR process?

WORK RVU BY SPECIALTY CALCULATOR - TOP 50 CPT® CODES PRE-POPULATED   RVUs are very helpful in analyzing #medicalpractice #reimbursement performance. You can analyze your Medicare and commercial #payer reimbursement rates using this calculator.   You do not need a Box account to access this calculator. Here you go:   https://lnkd.in/gkQDiV2h

WORK RVU BY SPECIALTY CALCULATOR - TOP 50 CPT® CODES PRE-POPULATED   RVUs are very helpful in analyzing #medicalpractice #reimbursement performance. You can analyze your Medicare and commercial #payer reimbursement rates using this calculator.   You do not need a Box account to access this calculator. Here you go:   https://lnkd.in/gpQXW2Bm

“In CY 2025, the structure of the Part D benefit is updated to reflect provisions of the IRA that become effective on January 1, 2025. The CY 2025 updates include the following: A newly defined standard Part D benefit design consisting of three phases: annual deductible, initial coverage, and catastrophic coverage; A lower annual out-of-pocket (OOP) threshold of $2,000; The sunset of the Coverage Gap Discount Program (CGDP) and establishment of the Manufacturer Discount Program (Discount Program); and Changes to the liability of enrollees, Part D sponsors, manufacturers, and CMS in the newly defined standard Part D benefit design.”