Florida Dermatology Billing: The Vendor Evaluation Questions That Reveal CO-50 Defense and Mohs Billing Capability

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Choosing a medical billing or RCM vendor for a Florida dermatology practice requires more than comparing collection percentages and monthly fees. Dermatology billing has specialty-specific risks, particularly when a practice performs Mohs micrographic surgery, pathology-related services, biopsies, and other procedures where documentation, medical necessity, coding, and payer policies directly affect reimbursement. One important area to examine is the vendor's ability to prevent and defend CO-50 denials . CARC 50 indicates that a service was considered non-covered because the payer did not determine it to be medically necessary. CMS guidance also shows that CO-50 can be used following medical review when a payer determines that coverage requirements have not been met. For a Florida dermatology practice, the vendor evaluation process should therefore go beyond asking, "How much do you collect?" The better question is: "How do you protect our revenue when a payer challe...
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Expanding Medicare Telehealth Use after PHE

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CY 2023 Medicare Physician Fee Schedule Proposed Rule

On 7th July 2022, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. This calendar year (CY) 2023 PFS proposed a rule that made lots of provisions including expanding Medicare telehealth use even after the end of a public health emergency (PHE).

Expanding Medicare Telehealth Use after PHE

For the calendar year 2023, CMS is proposing a number of policies related to Medicare telehealth services including making several services that are temporarily available as telehealth services for the PHE available through CY 2023 on a Category III basis, which will allow more time for collection of data that could support their eventual inclusion as permanent additions to the Medicare telehealth services list. CMS is proposing to extend the duration of time that services are temporarily included on the telehealth services list during the PHE, but are not included on a Category I, II, or III bases for a period of 151 days following the end of the PHE, in alignment with the Consolidated Appropriations Act, 2022 (CAA, 2022).

CMS is proposing to implement the telehealth provisions in the CAA, 2022 via program instruction or other sub-regulatory guidance to ensure a smooth transition after the end of the PHE. These policies extend certain flexibilities in place during the PHE for 151 days after the PHE ends, such as 

  • allowing telehealth services to be furnished in any geographic area and in any originating site setting, including the beneficiary’s home, 
  • allowing certain services to be furnished via audio-only telecommunications systems, and 
  • allowing physical therapists, occupational therapists, speech-language pathologists, and audiologists to furnish telehealth services. 

To learn more about Expanding Medicare Telehealth Use after PHE, click here: https://bit.ly/46fYgsF Contact us at info@medicalbillersandcoders.com/ 888-357-3226.

Location: United States

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