Pinnacle is conducting a four-part series to delve into the upcoming 2024 ICD-10 CM code changes and break them down chapter by chapter.  On June 16, 2023, The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2024 ICD-10-CM code set, which is set to take effect October 1, 2023.  With 395 new code additions, 25 deletions, and 13 revisions, read on to learn more about changes within chapters 1-22.

Part One: Chapters 1-6

Chapter 1 – Certain infectious and parasitic diseases (A00-B99)

Two (2) new code additions ...

The Centers for Medicare & Medicaid Services (CMS) has put forth a proposed rule that outlines significant changes to the Medicare Shared Savings Program (Shared Savings Program) for the calendar year (CY) 2024. The aim of these proposed changes is to further advance CMS’ value-based care strategy, promote growth, alignment, and equity in the program, and address concerns raised by stakeholders, particularly accountable care organizations (ACOs). A large part of the strategy refresh for value-based care comes from the bold goal to have all Medicare fee-for-service beneficiaries in a care relationship with accountability for quality and total cost ...

Abstract

On May 15, 2023, Envision Healthcare Corp. (“Envision”) announced that it and several of its subsidiaries had filed voluntary petitions for reorganization under Chapter 11 of the United States Bankruptcy Code.  This news prompted a swift reaction within the healthcare industry as Envision reports itself as “one of the nation’s leading medical groups, delivering physician and advanced practice provider care in settings where patients have the most acute and life-changing needs – emergency departments, surgical suites, intensive care units and birthing suites – through Envision Physician Services.”   Because of its large role in the ...

Healthcare Real Estate Transactions

Mountain Point Medical Center – Salt Lake City, UT.  JLL Capital Markets, Medical Properties Group announced the sale of Mountain Point Medical Center, a 60,000 square foot medical office building connected to the 40-bed Holy Cross – Mountain Point hospital in Lehi, Utah. The property is 100 percent leased to Centura Health, a non-profit faith-based health care system based in Colorado with 25 hospitals located throughout Colorado, Utah, and Kansas.

Charleston Cancer Center – Charleston, SC.  JLL Capital Markets announced it arranged the $10.1 million sale of the Charleston Cancer Center, totaling 26,256 ...

Traditionally, carotid endarterectomy has been the primary method of treating high-grade asymptomatic and symptomatic carotid artery stenosis. However, a minimally invasive technique known as carotid artery stenting (“CAS”) has evolved over the years.  This technique offers reduced postoperative pain, reduced potential for postoperative wound complications, and shorter hospital stays.

On July 13, 2023, The Centers for Medicare and Medicaid Services (CMS) released a draft decision memorandum regarding carotid artery stenting that would expand coverage of the procedure and remove certain requirements for CAS facilities and operators.

The proposal is a result of a national coverage analysis ...

COVID-19 public health emergency (PHE) ended on May 11, 2023.

Medicare’s coverage of telehealth for outpatient services will be extended through the end of 2024. Patients may continue to receive telehealth services no matter where they are in the United States and may receive services in their home rather than going to the health care facility.  Although private insurance often follows Medicare’s lead, they may decide to alter their telehealth coverage earlier.

Permanent Medicare Changes

• Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) can serve as a distant site provider for ...

While mental health awareness month occurred in May, we need not forget the upcoming changes to Medicare Advantage members in CY 2024 and beyond.

On March 31, 2023, The Centers for Medicare and Medicaid Services (“CMS”) released the CY 2024 Advance Notice for Medicare Advantage and Part D.  This advance notice will change everything we know about Risk Adjustment and Hierarchical Condition Category (HCC) Coding.

In the final notice, CMS deleted forty (40) ICD-10-CM diagnosis codes that currently map to an HCC in version 24 that will no longer map to a payable HCC in version ...

Pinnacle has reviewed the proposed rule changes for CY2024 related to the Medicare Physician Fee schedule.  CMS has also published a fifteen (15) fact-sheet summary.  The condensed overview below was constructed to provide an at-a-glance topic list of the proposed changes awaiting public comment before it is finalized.  We hope this is helpful to allow our colleagues to peruse the list and investigate further any details that may affect their practice.

• Medicare Conversion factor: decreased from $33.89 (2023) to $32.75 (2024), representing an across the board decrease in reimbursement of 3.34%.
• Supporting & expanding patient access and care ...