Part B News | Part B News

Watch for revised MDM, new guidelines in the ED code update

08/08/2022

Focus on codes 99281, 99282 and 99283 when you study the revised descriptors and guidelines for emergency department (ED) E/M visits recently released by the AMA. The end of the three-component concept — history, exam and medical decision making (MDM) — for all level-based E/M codes prompted significant changes to these codes and will go into effect Jan. 1, 2023.

Proposed ACA rule adds language, oversight roles, advances LGBTQI+ care

08/08/2022

by: Roy Edroso

HHS and its Office for Civil Rights (OCR) unveiled a new proposed rule on July 25 interpreting the civil rights protections covered by Section 1557 of the Affordable Care Act (ACA). The rule contains new sections on “gender-affirming” care, though many providers will find extra training, oversight and language services that they may be required to provide more pressing to their practices.

Speed E/M code selection with a family-to-place-of-service crosswalk

08/08/2022

by: Julia Kyles, CPC

Help your staff connect E/M visits in the nursing facility and home with the correct place of service (POS) code with an E/M-family-to-POS crosswalk.

CMS proposes to bundle pricey skin substitute products in pro fee

08/08/2022

by: Laura Evans, CPC

A year after it finalized a policy to allow carrier-priced payment in the physician office for some synthetic skin substitutes, CMS is proposing more dramatic reimbursement changes for the implants. Specifically, the agency wants to bundle payment for these often expensive wound care products into the physician’s professional payment as “incident-to” expenses starting in 2024.

Directory glitch caused patient overcharge? Under NSA, you pay, not the plan

08/08/2022

by: Roy Edroso

Question: I know the No Surprises Act (NSA) and the CMS rules that put it in practice require that provider directories be kept up to date. But I thought that was all the insurers’ responsibility. The other day I was looking at guidance from a CMS’ Center for Consumer Information & Insurance Oversight (CCIIO) that says, among other things, “Under the No Surprises Act, providers and health care facilities must generally ... refund enrollees amounts paid in excess of in-network cost-sharing amounts with interest, if the enrollee has inadvertently received out-of-network care due to inaccurate provider directory information.” Why is this the providers’ responsibility?

At top and bottom of 2023 fee changes, some big hits, soft landings

08/08/2022

by: Roy Edroso with additional reporting by Laura Evans

The almost 4% proposed cut to the 2023 conversion factor would, if finalized, have a powerful negative effect on many of the most-used Part B procedure and E/M codes. Factoring in changing relative value units (RVU) reveals some big winners and losers on a per-service basis.

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