Part B News | Part B News

Inflation Reduction Act caps insulin costs, grants CMS drug negotiating power

08/29/2022

Many of the health care changes in the Inflation Reduction Act, signed into law by President Biden on Aug. 16, will be rolled out over time, but the effect of the insulin cost ceiling and other aspects of the law are likely to have a more immediate impact on your patients.

Focus on practitioner preference, end users when you update E/M templates

08/29/2022

by: Julia Kyles, CPC

Make sure treating practitioners and coding staff work together when the practice revises its electronic health record (EHR) templates ahead of the next round of E/M changes (PBN 7/11/22). The second E/M update will move the remaining level-based codes to the office/other outpatient model and gives your practice the opportunity to rethink and improve its templates.

For patients with challenges, hearing aid rule gives providers OTC options

08/29/2022

by: Roy Edroso

The final rule on over-the-counter hearing aids from HHS and the Food and Drug Administration (FDA) clears a new category of sub-prescriptive hearing devices that may offer your patients a welcome alternative.

Don’t let OIG fraud alert disrupt your practice’s telehealth program

08/29/2022

by: Julia Kyles, CPC

The latest special fraud alert warned treating practitioners about telemedicine companies that recruit providers in order defraud Medicare and other programs (PBN 8/15/22). However, the alert should not discourage you from using the COVID-19 public health emergency (PHE) waivers to provide telehealth services to your patients.

Use these strategies when a payer inappropriately uses modifier 50

08/29/2022

by: Laura Evans, CPC

Question: We recently sent a claim to Blue Cross of Alabama that included 20610-LT for a left shoulder diagnosis and 20610-RT for a right knee diagnosis. The payer responded that we should have billed these procedures on one claim line with a 50 modifier (bilateral procedure). We replied that this was not a bilateral procedure, but rather two separate procedures done in two separate joints. The payer then stated that because code 20610 has a bilateral surgery indicator of “1” in the Medicare physician fee schedule, modifier 50 should be used rather than RT/LT. There doesn’t seem to be any way to report a major joint arthrocentesis done on different joints on opposite sides of the body. Is there a way to correct the situation?

Turn to modifier 91 for repeat laboratory testing

08/29/2022

by: Sarah Gould, CPC

Question: We are getting some National Correct Coding Initiative (NCCI) edits for repeat laboratory services. What modifier do we use if a component of a panel test is repeated later?

Part D plan preference for higher-cost hepatitis C drugs led to higher Medicare and beneficiary spending

08/29/2022

by: DecisionHealth

On August 11, the OIG published a review of the utilization of hepatitis C drugs in Medicare Part D compared to utilization of the same drugs in Medicaid in 2019 and 2020. The review was conducted because preliminary research indicated that Part D beneficiaries were using higher-cost hepatitis C drugs rather than the generic versions that were increasingly being used by Medicaid beneficiaries.

Medicare costs, enrollment inch up, and so does patient burden

08/29/2022

by: Roy Edroso

While some of your patients will find relief under the Inflation Reduction Act (IRA), their financial contributions to coverage continue to rise, according to CMS’ most recent FastFacts program data. Federal health care programs continue to grow, as well, although none of the Medicare programs are picking up members as quickly as Medicaid.

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.