Part B News | Part B News

Prior auth still plagues practices, but CMS, lawmakers remain idled

03/21/2022

Despite heightened awareness of its negative impact on care, prior authorization (PA) appears to remain at least as much of a problem as ever. But some reformers are pushing at both the state and federal levels for tech fixes and so-called gold card programs to relieve the burden.

Code bundles coming in April target path and lab services

03/21/2022

by: Richard Scott

You’ll find more than 4,000 new code bundles taking hold in April, as CMS updates its National Correct Coding Initiative (CCI) automatic billing levers. Effective April 1, the bulk of the CCI version 28.1 edits involve codes found in the pathology and laboratory section of the CPT manual.

Resist the temptation to use Medicare’s risk examples for office visits

03/21/2022

by: Julia Kyles, CPC

Question: The CPT guidelines for E/M office visits (99202-99215) do not include examples of tests or treatments that are low risk or minimal risk. Our coders aren’t sure how to score risk for some encounters, so they send questions to the providers, which has had a negative impact on everyone’s productivity. Can we continue to use the examples of low and minimal risk management options from Medicare’s table of risk to code our office visits?

How to handle an undercover sting: Cooperate, and ensure it’s credible

03/21/2022

by: Roy Edroso

Question: If one of my providers is caught in an undercover “sting” by a state or federal agency, is the practice obliged to defend the provider? If the agency asks for the practice’s cooperation, are we obliged to give it? If the provider gets arrested, are we obliged to defend them?

ACO REACH tweaks help smaller group practices, promote health equity

03/21/2022

by: Roy Edroso

Experts unlimited are getting a closer look at the ACO REACH model CMS suddenly unveiled in February, and it’s looking good for ACOs who don’t have financial resources, as well as for the advancement of CMS’ health equity cause.

Care delays, staff burden: PA process still rankles, worries

03/21/2022

by: Richard Scott

The long-standing challenge of the prior authorization (PA) process, which providers have cited as an impediment to care for years, has not become easier to navigate and still puts patients at harm, industry surveys indicate.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.