A new regulation has been released regarding Medicare Advantage plans. If you are providing home health services to a patient enrolled in a Medicare Advantage plan, you are now required to issue the Notice of Medicare Non-Coverage. This notice must include information about the BFCC-QIO, allowing patients the opportunity to appeal decisions related to their discharge. […]
Healthcare providers have been facing significant challenges with PCR (Pre-Claim Review) requests in recent months, following a new directive from CMS (Centers for Medicare & Medicaid Services) to Palmetto GBA. The change in interpretation, which began impacting providers in late November, requires a face-to-face encounter performed by the certifying physician or nurse practitioner (NP) for […]
The Centers for Medicare & Medicaid Services (CMS) has announced that the Hospice Benefit Component of the Value-Based Insurance Design (VBID) Model will officially end on December 31, 2024, at 11:59 PM. This decision impacts Medicare Advantage Organizations (MAOs) participating in the Hospice Benefit Component and requires them to make adjustments to ensure continued compliance […]
CMS has announced the updated Medicare Part B premiums and deductibles for 2025. These changes, which reflect adjustments for rising healthcare costs and program expenses, are critical for providers to understand as they plan their billing and patient communications for the year ahead. 2025 Updates to Part B Premiums and Deductibles Premium Increases Deductible Changes […]
CMS has released the Calendar Year (CY) 2025 Medicare Physician Fee Schedule (PFS) Final Rule, outlining key updates to payment policies, payment rates, and other provisions under Medicare Part B. These changes directly affect physicians and healthcare providers across the country, influencing reimbursement rates and practice operations. Key Updates in the 2025 Fee Schedule 1. […]
Novitasphere, a vital online portal for Medicare providers, is undergoing a significant redesign to improve user experience in 2025 and beyond. This enhanced portal offers a modernized layout, better navigation tools, and new features designed to streamline billing and claims management for healthcare providers. To ensure a smooth transition to this updated system, Novitas Solutions […]
We are thrilled to announce that Precision Medical Billing (PMB) has officially been certified as a Great Place to Work—a prestigious recognition that is awarded based on employee feedback and the company’s commitment to creating an outstanding workplace culture. This achievement underscores our dedication to fostering an environment where every team member feels valued, supported, […]
The upcoming public reporting of the OASIS Section GG items, particularly GG 0130 and GG 0170, will impact home health agencies’ quality scores starting January 1, 2025. Ensure your team understands the reporting requirements for the Discharge Function Score, Home Health Quality Reporting Program (HH QRP), and Home Health Value-Based Purchasing (HHVBP) program.
A recent analysis shows a steady increase in prior authorization denials for Medicare Advantage (MA) beneficiaries, creating challenges for home health agencies. With denial rates on the rise, agencies must stay informed about MA payer guidelines to prevent delays in care.
Several hospice agencies have reported erroneous claim denials under Medicare error code 17729. This issue is affecting claims related to specific physicians, where claims process smoothly if the certifying physician’s SOC date is prior to June. However, claims with SOC dates in June and onward are being denied even after meticulous verification of the physician’s […]