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 ...

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 ...

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.

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 ...

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 ...

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 ...

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, ...

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 ...

The Centers for Medicare and Medicaid Services (CMS) issued the FY 2023 Final Rule, which required hospitals to report the new Inpatient Quality Reporting (IQR) program to submit two (2) new measures (SDOH-1) and (SDOH-2).  The measures were voluntary in FY 2023; however, are required in FY 2024.

On September 6, 2023, CMS released the Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z-Codes.  The data informatic was very “busy,” so Pinnacle is going to break down the information for you!

What Are Z-Codes?

• SDoH-related Z-Codes are located within categories Z55-Z65 in the ICD-10-CM diagnosis coding manual.
• Used to ...

Some facilities allow for a medical graduate training program where residents and medical students can participate in the care of patients under the direction of a licensed attending physician (teaching physician). This allows the residents and medical students to further expand their medical knowledge and get real-world experience with their patients and colleagues.  Teaching physician services have specific documentation requirements, and it is important to understand these requirements to stay in compliance with CMS regulations.

Per CMS guidance and policy, “When billing Evaluation and Management (E/M) services for a teaching physician you must look for, at a ...