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Medicare Reimbursement Hot Topics


About this program


Health insurance reimbursement has a major impact on the healthcare practice's vitality and success, and Medicare plays a key role in provider reimbursement. Private payer often follow suit. Stay informed of Medicare policy changes and trends and understand their policies beyond the shift to value-based services and patient-centered care to better position your providers for proper and successful reimbursement. It truly pays to keep up with recent news and trends from CMS.

With the end of the Congressional mandated suspension of payment for Office and Outpatient (O/O) Evaluation and Management (E/M) Visit Complexity Add-on Code G2211, CMS finalized its rule to make the code separately payable effective January 1, 2024. Procedure Code G2211 allows additional payment for physicians and non-physician practitioners with a longitudinal relationship with a patient. Ensure your billing staff and providers know about the code, understand the documentation requirements, and have access to the most current guidance for using it. Gain insight into why some recent claim denials for the code have occurred.

CMS is committed to reducing disparities in health for people from underserved and disadvantaged communities and advancing health equity. A new HCPCS stand-alone G code is in use to pay for administering a Social Determinants of Health Risk (SDOH) Assessment. Learn about this and other reimbursable Health Equity Services included in the 2024 Physician Fee Schedule. New service codes have been created describing Principal Illness Navigation (PIN), Community Health Integration (CHI), and Caregiver Training Services (CTS). Get the facts on their proper use and related supervision requirements.

Review updates to the Medicare Annual Wellness Visit (AWV) and ensure your providers are not missing opportunities to receive optimal reimbursement for services rendered.