The transition from V24 to V28 of the HCC model is almost in the rear view mirror. For most groups with risk contracts, this really is old news. We’ve left the video for another year for anyone who needs to catch up on the overview of the change. CMS pays Medicare Advantage (MA) plans using […]
Archives for November 2023
Age and Wellness Visits | Eligibility for Welcome to Medicare
Who can perform the AWV Knowing which Medicare wellness visit to bill Eligibility requirements for the Welcome to Medicare visit AWV and chronic care management A few years ago, I gave an AWV presentation at a family medicine conference and afterwards a physician said to me, “What you just told me will pay for the […]
Facility versus Non-Facility in the Physician Fee Schedule
Understanding facility versus non-facility in the physician fee schedule explains the total RVU and payment differences that practices receive when performing the same service in different settings. The Medicare Physician Fee Schedule has values for some CPT® codes that include both a facility and a non-facility fee. Some services may be performed in either an […]
What is a Coverage Policy?
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare coverage policies that describe medical necessity for certain services. Individual Medicare Administrative Contractors develop LCDs. These policies describe the service and covered indications. They can also include what professionals may perform the service. Some describe conservative treatments that must be tried before the procedure […]
HCPCS Code G0136 Update
CMS is changing the definition of HCPCS code G0136. They are keeping the code, and the valuation of the code. The code is staying on the telehealth list. But there is a completely new definition. Between now and 12/31/2025, G0136 is for an assessment of a patient in the areas of social determinants of health […]