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Direct pay rule creates opportunity for PAs, but states must act

02/28/2022

The final 2022 Medicare physician fee schedule includes a section that authorizes direct payments to physician assistants (PA), but practices don’t have to update the enrollment of PAs on staff. In addition, the rule needs to be backed by changes at the state level to make a difference to practices, alter current roles and ameliorate the continued shortage of primary care providers.

Reserve modifier FT for surgeon’s critical care unless your MAC says otherwise

02/28/2022

by: Julia Kyles, CPC

From Medicare’s first announcement that it would create a new modifier for critical care services during an unrelated procedure’s global surgical period, modifier FT has been a source of confusion. Practices in many states are still waiting for detailed, official guidance from their Medicare administrative contractors (MAC), including which provider is eligible to report it.

Turmoil over Direct Contracting model has CMS mulling changes

02/28/2022

by: Roy Edroso

Rumblings in Washington threaten CMS’ Global and Professional Direct Contracting (GPDC) model, generally known as Direct Contracting. Experts expect the program to survive the challenge, but possibly with alterations to appease stakeholders who find the current model too friendly to large non-provider organizations.

Time to reevaluate how we evaluate coding performance

02/28/2022

by: Lawrence A. Allen, MBA, CPC, CPMA, CEMA

Over the past 25 years, medical coding has grown more critical to the success of an organization’s health care revenue cycle. Qualified coding professionals continue to be in high demand, despite the proliferation of electronic health records (EHR) and associated billing systems. Given the importance of this function, evaluating coders’ performance is an essential task for revenue integrity. The question is — is it time to reevaluate how we evaluate performance?

CMS make hundreds of CCI edit fixes in mid-quarter update

02/28/2022

by: Laura Evans, CPC

CMS has posted an unscheduled mid-quarter update to its National Correct Coding Initiative (CCI) procedure-to-procedure (PTP) claims edits. The change, with a posting date of Feb. 4, 2022, comprises reissued PTP edit files for both hospitals and practitioners.

Beyond E/M: NPs, PAs regularly clock blood draws, AWVs, skin procedures

02/28/2022

by: Roy Edroso

The increased Medicare billing of the leading non-physician providers – nurse practitioners (NP) and physician associates (PA) – is buoyed by E/M claims, given that these practitioners have become a major part of patient intake in practices. But their share of procedure codes also is increasing.

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