Various approvals, exceptions, and new PCS codes that may potentially lead to additional payments.
The Centers for Medicare & Medicaid Services (CMS) desires to use the best data available when rate setting for the upcoming fiscal year. Because COVID-19 unsettled the playing field within the healthcare arena, CMS made the decision to use data from 2019 instead of 2020 due to the COVID-19 public health emergency (PHE). CMS is finalizing a one-year extension of New Technology Add-on Payments (NTAP) for 13 technologies for which the new technology add-on payment would otherwise be discontinued beginning FY 2022.
New covid treatment add on payment (NCTAP) is eligible for discharges during the PHE. In addition, CMS predicts inpatient covid cases will continue to be treated beyond the expiration of the Public Health Emergency. To mitigate potential financial pitfalls for hospitals treating covid patients, CMS is extending the NCTAP for eligible COVID-19 products through the end of the fiscal year in which the PHE ends. CMS is inserting measures for NCTAP that are discontinued but may still be eligible for NTAP. The goal is to prevent double dipping. Hospitals, however, will be eligible to receive both NCTAP and the traditional new technology add-on payment for qualifying patient stays, through the end of the fiscal year in which the PHE ends. The new technology add-on payment will reduce the amount of the NCTAP. For example: Fiscal year ends Sept. 30, 2022, but if the PHE is declared over by Dec. 25, 2022, (a Christmas miracle), the payment would remain in effect until the new fiscal year begins on Oct. 1, 2023.
The NCTAP is the lesser of the following:
Several new technology substances, services and devices were on schedule to be phased out this year, but a one-year extension was granted. Some can be an add-on status for two to three years before being discontinued. Some from 2020 are in their last year for 2022.
Hospitals are encouraged to report the PCS code for the various type(s) of covid treatments. Many hospitals have implemented measures to ensure NCTAP are not omitted during billing via checks and balances. For instance, the finance department can run report of accounts with NCTAP charges without a PCS code. These accounts are then sent to Health Information Management account review and remediation if necessary. This is not an uncommon practice and is often used for NTAP relating to new technology or drugs unrelated to covid.
It is not unusual for the cost of treating a covid patient to exceed the assigned MSDRG payment. Consequently, it is imperative to implement measures which ensure treatments are accurately captured. Equally important is the need to capture NTAP.
There are 42 technologies eligible to receive add-on payments for FY 2022. CMS estimates $1.5 billion in Medicare spending for FY 2022 – a 77 percent increase over fiscal year 2021.
Programming Note: Listen to Susan Gatehouse report this story live today during Talk Ten Tuesdays at 10 Eastern.
UnitedHealthcare (UHC) Medicare Advantage will begin reinforcing denialsbased on its interpretation of the International Classification of Disease, 10 thEdition, Clinical Modification (ICD-10-CM) Excludes 1.(https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-reimbursement/rpub/UHC-MEDADV-RPUB-JAN-2026.pdf) As
H.R. 1 doesn’t directly rewrite ICD-10 or CPT, but it does change the environment in which you’re coding. The impact is mostly indirect – through
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
