Navigating CMS Audits: Understanding the Different Types
For healthcare providers, CMS audits can be a daunting reality. Whether it is a RAC audit looking for overpayments, a CERT audit measuring error rates, or a UPIC audit investigating fraud, understanding the differences between these audits is crucial.
GENICULAR ARTERY EMBOLIZATION – REIMBURSEMENT CHALLENGES
The challenges with genicular artery embolization (GAE) reimbursement vary across carriers. Some payers consider this procedure to be experimental and, therefore, partially or fully deny reimbursement for the associated CPT codes.
2025 CPT Changes for Radiology, Interventional & Cardiology Specialists
Newly released 2025 CPT Changes for Radiology, Interventional, and Cardiology Specialists have increased in comparison to the last few years. Make sure your radiology coding, interventional coding, and cardiology coding service teams are current on these changes. StreamlineMD is ready and here to help!
Key Insights on CMS 2025 Final Payment Rules Impacts on Wound Care Providers
The Centers for Medicare & Medicaid Services (CMS) recently released the 2025 final payment rules, which include impacts on wound care. These rules significantly affect the U.S. healthcare system. Below is a summary of the most important provisions in the 2025 Medicare Physician Fee Schedule (MPFS), Hospital Outpatient Prospective Payment System (HOPPS), and Home Health Prospective Payment System (HHPPS).
Telehealth 2025: Congressional Action Needed on CMS Final Rule
On November 1, 2024, CMS released the CY 2025 Medicare Physician Fee Schedule (MPFS) Final Rule, outlining significant changes to telehealth policies effective January 1, 2025. Without Congress’ intervention, these updates could severely limit access to telehealth services for Medicare patients.
2025 Endovascular & Interventional OBL vs ASC Fee Impact Analysis
In this blog we analyze the 2025 CMS Final Rule’s reimbursement impact on image-guided procedure specialists performing services in Office/OBL (POS 11) and ASC (POS 24) environments.
2025 MPFS: Key Updates on Telehealth and Frequency Limitations
The Centers for Medicare & Medicaid Services (CMS) has proposed significant updates for the 2025 Medicare Physician Fee Schedule (MPFS). Among the most noteworthy are the extensions of telehealth flexibilities and revisions to frequency limitations.
ASC Complexity Codes for Interventional Cardiac Cath Procedures
The following outline highlights the key aspects of Medicare coding and billing for procedures performed in ASCs, particularly focusing on the new complexity codes introduced in 2023 and their impact on 2024 billing.
OIG Adds Lower Extremity Revascularization Procedures to 2025 Work Plan
The OIG will apply greater scrutiny to lower extremity revascularization procedures as part of its 2025 work plan
BCBS is Reducing Payment for E/M Service on the Same Day as Procedure
Recent payer policies will only reimburse 50% when an E/M and procedure are performed on the same day. Payers are now adding a layer of complexity by reducing the Evaluation and Management (E/M) service payment by 50% when a separately identifiable E/M service is provided in addition to the minor procedure performed. The use of […]