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The individuals who appear are for illustrative purposes. All persons depicted are models and not real healthcare professionals. US-N/A-2400043 05/24

Introducing the JZ Modifier

Introducing the JZ Modifier

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...
2023 CMS Final Rules HOPPS and MPFS

2023 CMS Final Rules HOPPS and MPFS

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...
Relative Value Units

Relative Value Units

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...
National Correct Coding Initiative (NCCI) Edits

National Correct Coding Initiative (NCCI) Edits

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...
Radiology Benefit Managers (RBMs)

Radiology Benefit Managers (RBMs)

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...
Medicare Administrative Contractors

Medicare Administrative Contractors

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...