Pinnacle's Blog & Publications

  • 2024 Final Rule Part Four: Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)

    Posted On: February 15, 2024

    The Centers for Medicare and Medicaid Services (CMS) included some changes related to RHCs and FQHCs in the 2024 Final Rule.

    • As referenced in our second article, CMS will now allow addiction, drug, or alcohol counselors who meet the requirements of MHCs to enroll with Medicare as MHCs for both RHCs and FQHCs.
    • CMS has shown a commitment to rural communities by extending the definition of direct supervision to allow for virtual presence through December 31, 2024. In addition, the required level of supervision for behavioral health services will be furnished as “incident to” a physician or NPP’s ...
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  • 2024 Final Rule Part Three: Caregiver Training Services

    Posted On: February 8, 2024

    Effective January 1, 2024, the Centers for Medicare and Medicaid Services (“CMS”) established an active payment status for CPT codes 96202 and 96203 (caregiver behavior management/modification training services) and CPT codes 97550, 97551, and 97552 (caregiver training services under a therapy plan of care established by a PT, OT, SLP).

    Before we delve into the specifics of the codes, let’s look at CMS’ definition of a caregiver:

    “An adult family member or other individual who has a significant relationship with, and who provides a broad range of assistance to, an individual with a chronic or other ...

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  • 2024 Final Rule Part Two: Behavioral Health Services

    Posted On: February 1, 2024

    The 2024 Medicare Physician Fee Schedule Final Rule revealed some great advancements in behavioral health services and how CMS will allow them to be billed.  We will highlight some of those changes in this article, but be sure to review the official final rule sourced below.

     

    Starting January 1, 2024, marriage and family therapists (MFTs) and mental health counselors (MHCs) are permitted to bill for services through Medicare.  Addiction counselors or drug and alcohol counselors who meet requirements can be designated an MHC and enroll in Medicare as MHCs as well.

     

    Medicare defines both MFT and MHC services as “services for the ...

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  • 2024 Final Rule Part One: Split (or Shared) Evaluation and Management (“E/M”) Visits

    Posted On: January 25, 2024

    According to the Centers for Medicare and Medicaid Services (“CMS”), Medicare Physician Fee Schedule Final Rule:

     

    “Split (or shared) E/M visits refer to visits provided in part by physicians and in part by other NPPs in hospitals and other institutional settings.  For CY 2024, we’re finalizing a revision to our definition of “substantive portion” of a split (or shared) visit to include the revisions to the CPT guidelines.  For Medicare billing purposes, the “substantive portion” means more than half of the total time spent by the physician and or non-physician practitioner performing the split (or shared) visit, or a substantive part ...

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  • 2024 Final Rule Summary of Changes

    Posted On: January 18, 2024

    The 2024 Medicare Physician Fee Schedule Final Rule is packed with changes that will impact physician’s revenue. In this article, we provide an overview of some of those changes. Look for more detailed articles regarding these topics in our upcoming 4-part series.

    • The Centers for Medicare and Medicaid Services (“CMS”) reduced the conversion factor (“CV”) by 3.4%.
      • 2023 CV factor was $33.89.
      • 2024 CV factor will be $32.74.
    • The American Medical Association (“AMA”) added new codes for caregiver training.
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  • Responsible AI in Healthcare: Ethical Considerations While Navigating the Moral Maze

    Posted On: January 17, 2024

    Introduction

    In the labyrinthine world of healthcare, Artificial Intelligence (AI) is the Minotaur that promises both mighty solutions and moral conundrums. But before tackling these head-on, let’s take a page—or several—from Eric Topol’s insightful book, Deep Medicine. Topol offers a profound narrative on how AI can deepen and humanize the patient-provider relationship, not by replacing the clinician but by freeing them to operate at their empathetic best. The book delves into the potential of AI to transform healthcare through personalization, efficiency, and a renaissance of the care in healthcare, all while navigating the complexities ...

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  • Social Determinants of Health (SDoH): What You Need to Know Moving into 2024!

    Posted On: December 20, 2023

    As we all know, until the release of the 2024 Physician Fee Schedule Final Rule on November 2, 2023; SDoH assessments were “voluntary” reporting measures for the Centers for Medicare and Medicaid Services (CMS).  That will no longer be the case moving forward to January 1, 2024.

    To ultimately define the goals of both Joint Commission and the Centers for Medicare and Medicaid Services, CMS has established a stand-alone code G0136 for the assessment of Social Determinants of Health. CMS goes on to define SDoH into broad categories of assessment(s) including: economic stability, access to education along ...

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  • Three Value-Based Care Models That Continue the Shift Away from Fee-For-Service (FFS)

    Posted On: December 12, 2023

    This article discusses two forthcoming initiatives set to launch in July 2024, aimed at moving away from fee-for-service payments in healthcare. Additionally, it introduces a third model, the AHEAD Model, which is designed to transform state and regional healthcare systems by aligning multiple payers and improving overall population health while reducing costs. Furthermore, the article underscores the importance of primary care as the cornerstone of a high-performing healthcare system.

     

    The Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model

    The AHEAD Model, a new voluntary “state total cost of care (TCOC),” is focused on driving healthcare ...

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  • Calendar Year 2024 Physician Fee Schedule Final Rule – How do they affect ACOs? Are You Ready?

    Posted On: December 4, 2023

    The Centers for Medicare and Medicaid Services finalized changes to the 2024 Physician Fee Schedule – Medicare Shared Savings Program on November 2, 2023. The changes in the final rule aim to advance CMS’ value-based care strategy.  Here are some of the major highlights of the changes:

    • Quality Measure Collection Types. CMS established a new collection type for ACOs called the Medicare Clinical Quality Measure (CQM) starting January 1, 2025. This addresses the concerns ACOs had with Electronic Clinical Quality Measures (eCQMs), which would have required ACOs to submit quality measures on ALL populations, not just Medicare, ...
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  • Interventional Neuroradiology: A Specialty on the Rise

    Posted On: November 28, 2023

    Background

    With increases in technology and breakthroughs in the healthcare field, new and innovative medical specialties and/or sub-specialties are gaining prominence.  Amongst those specialties is the field of interventional neuroradiology – a marriage of radiology, neurology, and neurosurgery.  As discussed in the following sections, we examine the origins and purpose of the specialty as well as key trends and compensation considerations as this field is seemingly here to stay.

     

    What is Interventional Neuroradiology?

    In recent years, hospitals have seen an increased use in Interventional Neuroradiology, also referred to as “INR”.  As defined by Columbia ...

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Meet the Authors

Karen Pickering

RHIT, CCS

Senior Consultant


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