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Warning: OCR reports widespread breach notification failures

10/25/2021

Prepare for more scrutiny of your practice’s patient breach notification process, as a recent HHS Office for Civil Rights’ (OCR) HIPAA audit report reveals deficiencies in covered entities’ breach notification letters.

Take a 6-step test of your practice’s breach notification process

10/25/2021

by: Marla Durben Hirsch

No one likes to think that their practice will experience a HIPAA breach, but every practice must be ready to deploy a breach notification to patients before the 60-day deadline. A practice that doesn’t have a plan to inform patients affected by a breach of unsecured patient protected health information (PHI) will be exposed to patient anger, investigations and costly fines.

Spotted a claim error? Before appealing, consider resubmitting or reopening

10/25/2021

by: Roy Edroso

Question: I‘ve heard that, rather than waiting for a denial on a claim so I can request a formal appeal, I can ask to have my claim changed after I’ve submitted it to the Medicare administrative contractor (MAC). I’ve heard this variously called a “reopening” and a “resubmission.” My question is, how do I do it?

How to report debridement procedure with rash treatment

10/25/2021

by: Sarah Gould

Question: A wound care patient with a 25-sq-cm chronic foot ulcer presents with a new cellulitic rash, which is treated using topical medication. During the visit, the physician also surgically removes dead tissue from the ulcer. How would these services be reported in CPT?

First-level appeals drop, but success rate rises for Part B providers, DME

10/25/2021

by: Roy Edroso

If you’ve been doing better on Medicare appeals lately, you’re part of a trend. Between 2013 and 2020, the overall rate of success for providers and suppliers on redeterminations, the first level of formal Medicare appeals on claims denials, rose from 46.5% to 55% at Part B Medicare administrative contractors (MACs). And Part B durable medical equipment (DME) claimants did even better.

CY2022 CPT update: Hundreds of code changes cover E/M, surgical services

10/18/2021

by: Part B News Staff

Take a first glimpse of the 2022 CPT code set. The annual update, released by the AMA, reveals hundreds of code changes, including more than 240 new codes that usher in a batch of care management services, surgical procedures and pathology and laboratory testing.

Inside job: Use tech, common sense to repel employee threats to your cybersecurity

10/18/2021

by: Roy Edroso

Recent headlines about a practice employee who absconded with her boss’ password serves as a reminder that the biggest threat to your cybersecurity could be right under your own roof. Set some clear boundaries for your employees’ network access and be prepared to decommission them swiftly when it’s time to cut them loose.

10/18/2021

by: Julia Kyles

Include a review of the amount in controversy (AIC) during your next training session for staff that works denials. Meeting the AIC is the only way to reach the third and fifth levels of appeal. Note that getting to the right amount isn’t as straightforward as adding up all the claims for a specific service that was denied for the same reason.

Time is right: Prepare for billing changes for therapy services

10/18/2021

by: Kimberly A. Hoy, JD, CPC

Therapy providers take note: Beginning Jan. 1, 2022, a 15% payment reduction for therapy services provided at least in part by a therapy assistant goes into effect. Modifiers CO for occupational therapy assistants (OTA) and CQ for physical therapy assistants (PTA) are used to trigger the payment reduction.

Prepare to sweep to-be-deleted codes from your claims billing

10/18/2021

by: Richard Scott

With the annual CPT code release now out, you’ll find hundreds of new, revised and deleted codes coming your way (see related story, p. 1). With numerous codes expiring, prepare to shift to alternative options for dozens of services and procedures in 2022.

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