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The end of the PHE is coming: Watch for EUAs, brace for hospital, Medicaid pain

02/13/2023

Some of the issues raised by the recent surprise announcement of the end of the COVID-19 public health emergency (PHE) — slated to draw to a close on May 11 — have been headed off by government action. For example, Medicare telehealth flexibilities will remain in place through 2024. But if federal and state authorities don’t act before May 11, some providers could still lose income streams as well as manpower.

Stay in place: Payer place of service errors spark observation claim denials

02/13/2023

by: Julia Kyles, CPC

If you experienced a recent surge of denials for observation visits, a payer error could be to blame. Four Medicare administrative contractors (MAC) have announced that they improperly denied claims for hospital inpatient and observation care codes and are working on the problem. The error affects claims for observation visits performed on or after Jan. 1 and is triggered by the place of service (POS) on the claim.

Are you up to date? COVID-era relief programs issue warnings

02/13/2023

by: Roy Edroso

A note from a Medicare administrative contractor (MAC) serves as a reminder that some federal programs in which you enrolled are still expecting payment or attestations, and if you aren’t aware of that you’re still liable.

Expect HIPAA compliance to wind up when the PHE winds down

02/13/2023

by: Julia Kyles, CPC

Hope for the best, prepare for the worst and don’t be surprised by anything in between while you prepare for the return of HIPAA rules for telehealth services.

Be careful about upcoding; DOJ may come after it as a false claim

02/13/2023

by: Roy Edroso

Question: I recently saw a Department of Justice settlement in North Carolina that seemed to be entirely based on a pattern of upcoding E/M. I didn’t know federal prosecutors did that! Is it common?

Monthly care management grew in 2021 – but with one surprise

02/13/2023

by: Roy Edroso

In the second pandemic year of 2021, care management codes, including complex and psychiatric collaborative codes, and principal care codes continued to creep up despite the general Medicare utilization downturn. However, in a significant reversal, the original CCM code 99490, the biggest biller of them all, turned negative.

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