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CMS widens scope of split/shared policy, firms up billing rules

11/15/2021

Prepare for major changes to the way your practice bills original split/shared services — traditionally performed in the hospital setting — that will go into effect Jan. 1, 2022. CMS will implement the new guidelines it released in the proposed 2022 Medicare physician fee schedule, but it added a transitional plan designed to smooth the switch to the new billing policy.

Clinical labor pricing gets reboot ahead of 4-year phase in period

11/15/2021

by: Richard Scott

CMS is launching a four-year initiative to fix flaws in its clinical labor pricing data. For the first time in two decades, the agency will update its non-physician labor inputs to bring them in line with current market and staffing trends.

COVID-era telehealth to remain through 2023. After that, the future is unclear.

11/15/2021

by: Roy Edroso

CMS finalized the extension of “Category 3” COVID telehealth codes through 2023 at least but did not execute bigger changes that would make many of them permanent.

Tough year, big change: MIPS players challenged on scores, then by MVP

11/15/2021

by: Roy Edroso

The delay on a full switchover to the MIPS Value Pathways (MVP) program may relieve anxious participants, but experts say it’s merely a reprieve in a Quality Payment Program (QPP) that is slated to undergo fundamental change in coming years. In 2022, in what may be the final year of traditional MIPS reporting, providers will face thresholds that are higher than ever, and participants who’ve been breezing through may find rougher going.

Shared Savings ACOs get two years to brace for heavy APP, eCQM lift

11/15/2021

by: Roy Edroso

CMS finalized the delay of controversial reporting changes for Shared Savings accountable care organizations (ACO), but stakeholders remain concerned that those changes will make the program significantly more difficult in the future.

Fee schedule round-up: Conversion factor cut, PAs freed and more

11/15/2021

by: Part B News Staff

The final CY2022 conversion factor, effective Jan. 1, falls about 4% to a rate of $33.59, down from $34.89 in 2021, according to the 2,414-page final rule released Nov. 2. The decrease is largely attributed to the end of the one-time payment increase that lawmakers authorized under the Consolidated Appropriations Act of 2021 (CAA) and comes despite intense lobbying by physician groups to stave off the year-to-year cuts.

CY2022 specialty impact: Final fee schedule winners and losers

11/15/2021

by: Richard Scott

While the 4% cut to the 2022 conversion factor is coming for all specialties, the impact of relative value unit (RVU) changes harbors its own outlook – fluctuating from a 6% gain for diagnostic testing facility to a -5% drop for interventional radiology and vascular surgery.

Soothe ‘great resignation’ squeeze on staff with a supportive workplace

11/08/2021

by: Roy Edroso

The story is unfolding day to day, but America’s normally robust health care employment environment appears to be getting squeezed by the exodus of workers across the country, a phenomenon being called the “great resignation.” Practice employers should acknowledge that this is probably not a transitory trend, and now is the time to take steps to improve retention and avoid costly hiring waves.

Navigate billing differences for coming principal care management codes

11/08/2021

by: Julia Kyles, CPC

Principal care management (PCM) may be more attractive to practices than traditional care management in 2022. The transition from temporary HCPCS codes to permanent CPT codes (99424-99427) includes new add-on codes that will allow practices to increase the revenue they receive for this service.

Audit, monitor, train: Stay compliant as OIG spotlights modifier 25

11/08/2021

by: Joe Rivet

Pay attention to your billing of E/M services and a minor procedure at the same encounter, because federal auditors are taking notice. In April, the Office of Inspector General (OIG) added a new item to its Work Plan titled “Dermatologist Claims for Evaluation and Management (E/M) Services on the Same Day as a Minor Surgical Procedure.” Despite the title, the application and overall concern about this concept is much broader than dermatology.

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