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Wave of federal risk adjustment investigations reveals pain points for providers

12/07/2020

Recent high-profile investigations of Medicare Advantage organizations (MAO) suggest that, as the program grows, investigators and auditors are getting more attentive to risk adjustment irregularities — and that this attention may eventually reach down to contracted providers.

The 3 elements of MDM: Get to know the refurbished ‘risk of complications’ category

12/07/2020

by: Laura Evans, CPC

To help subscribers prepare for the 2021 E/M office visit guidelines, Part B News will examine each of the three elements of medical decision-making (MDM) and how they will change starting Jan. 1. This issue previews the “risk of complications and/or morbidity or mortality of patient management.”

Telehealth update: Make sure to lock in medical necessity before billing phone E/Ms

12/07/2020

by: Laura Evans, CPC

While it’s true that Medicare is covering E/M visits performed via the telephone (codes 99441-99443) on a temporary basis during the public health emergency (PHE), practices should not take this as license to bill their patient phone calls as E/M visits, coding experts warn.

No, your EHR is not to blame for documentation or coding errors

12/07/2020

by: Julia Kyles, CPC

You’re not alone if you worry that your electronic health record (EHR) might create liability issues, but you will need to work with the vendor to change the system or create your own work-arounds to protect your practice.

Patient post-op pain? If it’s really unrelated to surgery, use modifier 24

12/07/2020

by: Roy Edroso

Question: Our surgeon did a knee replacement on a patient, which put her on a walker and crutches for an extended period of time. Using the crutches caused her back pain, and she saw the surgeon about it. Can the surgeon claim an E/M with modifier 24? Or is this considered a “related” condition?

2021 conversion factor gets 10% squeeze, E/M revisions remain on track

12/07/2020

by: Decision Health Staff

Physicians are facing a 10.2% drop in the Medicare conversion factor (CF) starting Jan. 1, as an offset to broad new increases in reimbursement rates for E/M office visits and other E/M-like services, according to the final 2021 Medicare physician fee schedule released Dec. 1.

Use of E/Ms with modifier 24 remains stable, but denial rates fall hard

12/07/2020

by: Roy Edroso

Considering its stringent requirements, you may expect claims with modifier 24 (Unrelated E/M service during a postoperative period) to see a lot of denials. But their rates are actually very low, especially compared to where they were four years earlier.

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