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The appropriate use criteria (AUC) “educational” year is soon to arrive, and it would behoove providers involved with advanced imaging to get in the swim before the results are made to count — which may require you to seek prior authorization for the affected tests.
In an ongoing effort to revise the documentation guidelines for E/M codes, CMS has proposed a new policy that includes elimination of history and physical exam as elements for code selection, allowing providers to choose whether their documentation is based on medical decision-making (MDM) or time (PBN 8/12/19).
A sweeping new Medicare enrollment final rule with comment period will eventually require all providers and suppliers to report even modest relationships with other entities whose debts, exclusions, revocations and suspensions may affect you: The rule would allow providers and suppliers to be kicked out if HHS thinks even this secondhand relationship “poses an undue risk of fraud, waste or abuse.”
Question: We have a new physician that has recently joined our surgical group. Some patients from her previous practice have elected to follow her to our practice. Are these patients considered new or established? The patients are new to our practice and tax ID number; however, they are not new to the physician who is providing care to them.
Alert your billing staff to several dozen code bundles that will restrict a range of same-day services, including some allograft procedures, when the latest Correct Coding Initiative (CCI) edits take effect Oct. 1.


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