For medical billers, so many things happened in the year 2021. So many policies were modified, new CPT codes were added, coverage was expanded, documentation guidelines were updated. Every insurance carrier had responded differently to all these changes, making their unique billing guidelines and reimbursement policies. Recently, the Centers for Medicare & Medicaid Services (CMS) finalized a few guidelines like expanding telehealth coverage even after the end of Public Health Emergency (PHE). In this article, we have shared major billing changes to watch for in the year 2022. Understanding all these billing changes will help to reduce claim denials and can improve practice collections.
Wider Coverage of Telehealth for Behavioral Health
CMS has extended coverage of telehealth services beyond the COVID-19 pandemic. CMS has extended Medicare’s coverage of telehealth for behavioral health visits, as per its final physician fee schedule for 2022. CMS has removed geographic restrictions around telehealth visits for mental health services. Medicare would cover visits in patients’ homes, including for diagnosis, evaluation, or treatment of mental health conditions. Medicare would also cover audio-only visits for some services, including counseling, therapy, and treatment for substance use disorders provided through Opioid Treatment Programs. It would also cover mental health visits offered by rural health clinics and federally qualified health centers. All these changes were intended to make mental healthcare available to people in areas with poor broadband infrastructure and in rural communities.
Change in POS Codes for Tele-Mental Health
Effective January 1, 2022, for tele-mental health Place of Service (POS) code 02 will be revised, and a new POS code 10 will be created. When providing telehealth services to patients in their own homes, providers will use POS code 10 and stop using POS code 02. POS code 10 does not apply to patients who are in a hospital or other facility where the patient receives care in a private residence, such as a nursing home or assisted living facility. In those situations, providers like psychologists will continue to use POS 02. The same will apply for Anthem and UnitedHealthcare (UHC), as they will require commercial and Medicare Advantage plans to use new place of service (POS) code 10 for telehealth provided in the patient’s home.
Billing Directly to Medicare for PA
Most practice owners have been looking for this change for a long time, the ability to bill directly, to reassign billing, even to incorporate with other physician assistants. They will get reimbursed at 85 percent as per the existing rule. This rule will change a lot of things, as medical organizations that have struggled with staffing, now have the capability of adding physician assistants onto the roster as care delivery opportunities. You just need to careful and while billing for PA services as you need to understand Medicare’s guidelines and credentialing requirements. Your medical billing team should be capable to bill accurately to receive reimbursement for PAs.
No Surprises Act
Starting 1st Jan 2022, health care providers will be required by law to give uninsured and self-pay patients a good faith estimate of costs for services that they offer, when scheduling care or when the patient requests an estimate. This new requirement was finalized in regulations issued on October 7, 2021. The regulations implement a part of the ‘No Surprises Act,’ enacted in December 2020 as part of a broad package of COVID and spending-related legislation. The act aims to reduce the likelihood that patients may receive a ‘surprise’ medical bill by requiring that providers inform patients of an expected charge for a service before the service is provided.
More Payments for Vaccines
In the year 2022, CMS will pay more for vaccines for influenza, pneumonia, hepatitis B, and other common diseases. It will nearly double Medicare Part B payments for administering these vaccines from $17 to $30. For Covid-19 vaccines, however, payments will remain the same, at $40 per dose.
To summarize, the year 2021 is composed of lots of billing changes and the year 2022 would be no exception. You need a solid medical billing team who understands all these billing changes and knows which of them are applicable to your practice. If you feel it’s difficult to keep up with all these billing changes, it’s advisable to connect with medical billing expert like MedisysData. Our billing experts are on top of all these billing changes and apply these guidelines as per your medical specialty. To know more on how we can add value to your medical billing and coding operations, contact us at 302-261-9187 / firstname.lastname@example.org