December 2024 Newsletter Highlights
A Note From Natalie
As we wrap up another remarkable year, I want to take this opportunity to thank you for being an essential part of our journey at Qualcode.
Your support has been instrumental in making this year a success. At Qualcode, we believe the holiday season is about reflecting on shared successes, cherishing relationships, and looking forward to brighter opportunities ahead. May your holiday season be filled with joy, peace, and time well-spent with loved ones. Here’s to a prosperous and inspiring 2025!
Remember: QualCode can help.
Natalie Williams ~ President & CEO
CMS reduces the timeframe for MACs to review certain prior authorizations
The specifics: Medicare recently announced that starting January 1, 2025, it would reduce the timeframe for MACs to review Medicare fee for service standard prior authorization requests to no more than seven calendar days. MACs currently have 10 days to respond. The timeframe for expedited requests remains two business days.
What’s next: Keep close tabs on prior authorizations in the New Year to ensure MACs comply with this new timeframe that will help providers ensure access to timely care.
Medicare shared savings program generates the largest savings in its history
The specifics: CMS recently announced that the Medicare shared savings program saved the agency more than $2.1 billion in 2023.
What’s next: Leverage this momentum to identify ways in which your own Account Care Organization (ACO) can improve cost containment and quality of care. Want to know what’s new for ACOs in 2025? Read this summary from the American Medical Association (see p. 7 of the PDF).
CY 2025 Medicare physician fee schedule final rule includes many new revenue opportunities
The specifics: On November 1, CMS published its CY 2025 Medicare physician fee schedule final rule that takes effect January 1, 2025. While the rule includes a 2.8% payment cut, it also includes many new payable medical codes, including codes for caregiver training services, new atherosclerotic cardiovascular disease risk assessment and risk management services, advanced primary care, and more. In addition, there are more opportunities to bill evaluation and management (E/M) visit complexity add-on code, G2211. Understanding clinical documentation requirements is key for all of these services.
What’s next: Review the rule and identify potential opportunities to improve patient care and generate more revenue through accurate medical coding.