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For patient notes, copy and paste with care to keep MDM on the level

05/09/2022

Set the record straight if your treating practitioners interpreted the guidelines for office E/M visits (99202-99215) as permission to use boilerplate or cloning to justify a higher code. Two recent CPT Assistant articles make it clear that cloning and coding based on medical decision-making (MDM) don’t mix.

Evolving ‘equity’ push by CMS signals a new front for providers

05/09/2022

by: Roy Edroso

A flurry of new proposals from HHS and CMS centered around “health equity” suggests that federal agencies may soon require providers to perform equity-related tasks, and experts believe data collection is likely to be the first attainable goal.

Watch federal ‘network adequacy’ standards for ACA plans

05/09/2022

by: Richard Scott

On April 28, CMS released the 2023 Notice of Benefits and Payment Parameters Final Rule, which issued new provisions for health plans operating on the federally-facilitated marketplace (FFM). The rule may serve to buoy access to physician providers, but in the longer term it could also have implications on your patient intake policies.

Unpack CPT coding for implant and foreign body removals

05/09/2022

by: Sarah Gould

When coding for removal or insertion, it’s imperative to understand the difference between a foreign body and an implant, and coders must be familiar with new CPT definitions for implants and foreign bodies that went into effect Jan. 1.

No time limit on incident-to billing if problems are unchanged

05/09/2022

by: Richard Scott

Question: I read your recent article about incident-to billing. One of my practitioners has a question I am unable to answer. Is there a time limit on what is considered a new problem? For example, if a patient is not treated for a particular problem in over a year, is it now considered a new problem? Please advise.

Hospital code use took double-digit hit in 2020, but denials stayed light

05/09/2022

by: Roy Edroso

Like many other services, hospital inpatient and observation numbers took a hit in the first pandemic year of 2020. But providers performed better in getting their claims accepted than before.

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