Medicare Changes: Understanding Quarterly and Annual Updates
As healthcare providers, we are well aware of the constant changes and updates in the medical industry. When it comes to Medicare, these changes can occur quarterly and annually, and staying informed is crucial to ensure smooth billing and compliance with regulations. In this post, we’ll explore the distinctions between quarterly and annual Medicare changes and the importance of monitoring them.
Quarterly Changes: Keeping an Eye on Updates
Medicare can adjust its policies and coverage yearly as a government-run healthcare program. These quarterly changes can include adding or removing Current Procedural Terminology (CPT) codes, altering fee schedules for certain services, and modifying definitions of CPT codes. While less significant than the annual changes, these updates still impact providers’ billing and reimbursement processes.
To stay updated on quarterly changes, we recommend signing up for newsletters from the Centers for Medicare and Medicaid Services (CMS) and regularly checking the CMS website for any updates or announcements. CMS usually issues quarterly updates, necessitating an office member’s designated role to stay informed about these changes.
Annual Changes: The Big Overhaul
At the beginning of each year, Medicare undergoes a more significant overhaul, implementing major changes that affect providers, patients, and payers alike. Annually, changes are disclosed in July of the preceding year, offering providers ample time to prepare for upcoming adjustments.
Annual changes may include:
CPT code changes can alter billing procedures when codes are added or removed from the list of covered services.
Reimbursement updates: The Relative Value Units (RVUs) for services may be adjusted, leading to changes in reimbursement rates.
Telehealth policies: Medicare may revise its telehealth coverage policies, impacting how providers can offer remote services.
Policy changes: Medicare may introduce new policies or alter existing ones to align with changing healthcare needs.
Anticipating and adapting to these annual changes is essential for maintaining efficient operations and complying with Medicare regulations. Providers and healthcare organizations must update their billing systems, fee schedules, and policies accordingly.
Why Stay Informed about Medicare Changes?
Even if you do not bill Medicare directly or have a limited number of Medicare patients, staying informed about Medicare changes is crucial. Commercial payers often follow Medicare’s lead regarding policies and reimbursement rates. Consequently, what starts as a Medicare change may eventually influence the practices of other insurance providers.
Being proactive and staying up-to-date on Medicare changes ensures your practice remains compliant and avoids pitfalls in billing and reimbursement processes.
Medicare changes occur annually and quarterly, impacting billing, coding, and reimbursement procedures. Healthcare providers must stay updated on these changes by subscribing to CMS newsletters and checking their websites regularly. Anticipating and adapting to Medicare changes is vital for maintaining the financial health of your practice and ensuring seamless operations.
If you have any questions or comments about Medicare changes or how to stay informed, please leave them in the comments section below. Thank you for reading, and take care!