2021 was not likely the year you expected. But it is the year you lived and learned. You focused on patients and despite changing guidelines, pivoted to stay compliant in your billing and coding. You juggled issues with new coding guidelines, claims, rejections, denials, payer-specific COVID-19 rules, and the Health Resources and Services Administration (HRSA) Uninsured program. Visit volume went up, and never decreased to pre-COVID benchmarks for many clinics. And here we are in 2022, wondering what surprises the year will bring. In this issue, we review some laws that may affect your business, explore cost-sharing for COVID-19 testing, and provide security and vaccination mandate tips. The fewer surprises, the better.
A new law was signed by Congress on December 10, 2021 to avert an average reduction in allowables. The Protecting Medicare and American Farmers from Sequester Cuts Act addresses the reduction in the 2022 Conversion Factor set by the Physician Final Rule. The new conversion factor becomes $34.61 compared to $34.89 in 2021. With the increase in Relative Value Units on most E/M codes, the impact to 2022 rates becomes minimal.
In addition, the new law extended the moratorium on the two percent Medicare sequestration cut until March 31, 2022 and reduces the cut to one percent from April 1, 2022 through June 30, 2022.
Use this chart to compare 2022 allowables against 2021.
Federal law requires all private insurance plans to cover the entire cost with diagnostic COVID-19 testing as long as the test is medically appropriate. Insurance plans do not have to cover screening. This is an important distinction. For clarity, the difference is defined below:
This requirement is restricted to group health plans and health insurance issuers offering group or individual health insurance coverage. It may not include self-funded plans.
For out-of-network (OON) testing, the payment amount is the cash price for testing listed by the practice on their public website. The patient cannot be balance billed.
It’s uncertain how long payers will be required to waive cost-sharing for COVID-19 testing but will likely depend on whether the Public Health Emergency is extended. On October 18, 2021, the U.S Department of Health and Human Services renewed the declaration through January of 2022.
State laws also affect cost-sharing requirements. Be certain to check your state guidelines for changes and updates that affect your service area.
Viruses are stealthy and move through your system undetected. Then one day, you realize that your computer isn’t healthy and shows the symptoms of chronic problems. Just like the human body with a virus, everything you do is a chore.
If your system is stumbling instead of running, you may be the victim of a malware attack. Use this list of nine common malware symptoms that suggest your computer has been infected with a virus.
If you are experiencing one or more of these activities on your computer or systemwide, contact your IT manager or your Experity team ASAP.
In November 2021, the Biden-Harris Administration issued emergency regulations requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. But since that time, states and state coalitions have mounted legal challenges to them in federal courts across the country, leaving some urgent care centers questioning the best steps forward.
With this battle taking place in the courts, providers will not likely have clear direction on the mandates for some time. In the meantime, here are a few steps you can take to support pandemic safety and compliance.
Interested in more? Our RCM experts use smart solutions and best practices to stay on top of revenue cycles and reimbursement.