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Four Changes to Medical Billing you can Expect Right now

By Remington College Posted June 12, 2022

If you describe yourself as a lifelong learner and love working in a role where there are constant changes, medical billing and coding might be right for you. Why? Because as science and medicine evolve, so too do the ways medical personnel organize data and bill patients.

Things like the COVID-19 pandemic and natural disasters mean those who work in medical billing and coding need to stay up-to-date on what’s new in the industry so they can continue to do their jobs well.

Curious about the latest in the field? Check out some recent developments in medical billing and coding you might want to be aware of.

On August 23,2021, the U.S. Food and Drug Administration (FDA) approved the Pfizer COVID-19 vaccine. This is the first COVID-19 vaccine to receive approval from the administration, and that  has prompted new billing guidelines. The vaccine previously shared emergency use authorization (EUA) with the Moderna and Johnson & Johnson vaccines.

There are now three new HCPCS Level II codes for COVID-19 therapeutic injections. On July 30, the “FDA revised the EUA for casirivimab and imdevimab to allow the drug combo to be used for post-exposure prophylaxis (PEP) in adult and pediatric patients who have been exposed, or who are at high risk for being exposed, to the SARS virus that causes COVID-19.” These are just a few of the most recent updates in the continually changing landscape of the pandemic. Those in the medical billing and coding industries have to stay up-to-date with all the latest information to be effective.  

On July 1, 2021, the U.S. Department of Health and Human Services (HHS) issued new regulations regarding surprise billing of consumers. These new provisions will restrict out-of-pocket costs paid by consumers for health care. Surprise billing happens when consumers unknowingly receive care that is outside of their health insurance’s network.
Some of the new provisions include banning surprise billing for emergency services and high out-of-network cost-sharing for emergency and non-emergency services. There is also a provision that bans out of network charges without advance notice.

These provisions are meant to protect consumers from financial ruin caused by misinformation on their coverage options.

In response to the public health emergency (PHE) prompted by Hurricane Ida, the Centers for Medicare & Medicaid Services (CMS) has issued a number of billing flexibilities to aid those in affected areas. These waivers are in addition to those that are already in effect as a result of the COVID-19 PHE.

One of the major flexibilities that has been issued is in regard to lost or damaged medical equipment. CMS is now waiving several requirements for beneficiaries that are usually necessary for replacement. In addition to that, CMS is ensuring access to care for those enrolled in Medicare Advantage (MA) and Part D by allowing benefits to be furnished at non-contracted facilities.