In the 2023 Centers for Medicare & Medicaid Services (CMS) Physician Fee Schedule Final Rule, CMS confirmed the implementation of the new
JZ Modifier. The JZ Modifier became available to use as of January 1, 2023, and is required to be implemented no later than...
CMS has finalized the rules for the 2023 Hospital Outpatient Prospective Payment System (HOPPS) and Medicare Physician Fee Schedule (MPFS). Please see below for some key information impacting diagnostic imaging payments for 2023. For more information on the HOPPS...
RVUs are the basic component of the Resource-Based Relative Value Scale (RBRVS), which is a methodology used by CMS and private payers to determine physician payment. RVUs are not the sole factor that defines physician compensation: the physician payment is determined...
CMS has developed coding edits in order to prevent improper payments. There are three different types of edits. Procedure to Procedure (PTP) edits prevent improper payment when incorrect code combinations are reported. Medically Unlikely Edits (MUE) are to prevent...
As a personal consumer of healthcare, you may be quite familiar with your Pharmacy Benefit Manager (PBM). When going to the pharmacy to pick up your prescription (Part D) drug, in order to have your your prescription covered by insurance you are asked to provide proof...
A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare medical claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary...
