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Social workers, psychology see RVU gains in 2025; a dozen are down

11/11/2024

Take note of relative value unit (RVU) changes for specialty-specific services within the final 2025 Medicare physician fee schedule. The projected gains in allowable charges for select specialty groups in 2025 are led by clinical social workers (+4%), clinical psychologists (+3%) and anesthesiology providers (+2%), who will see the biggest RVU gains on net.

As AI proliferates, keep its use ‘on-label,’ protect your data

11/04/2024

by: Roy Edroso

The use of generative artificial intelligence (AI) in health care continues its rapid expansion. But a recent investigation of one product’s possible flaws serves as a reminder that the technology remains immature and in many cases guardrails are required, especially when it impacts patient care.

Implement tips on split/shared billing from 3 top specialties

11/04/2024

by: Julia Kyles, CPC

Take note of tips for using modifier FS (Split or shared services) from top reporters as the modifier approaches its third year of active status. CMS implemented the modifier as part of a major revision to its rules for split/shared services, on Jan. 1, 2022. The modifier dictates payment, so accuracy is crucial to prevent overpayments, underpayments and compliance problems.

Overpayments rule would grant 180-day investigations. Is it enough?

11/04/2024

by: Roy Edroso

A little-noticed feature of the proposed 2025 Medicare physician fee schedule (PFS) having to do with the reporting and return of overpayments could be finalized soon, and it might change the timetable for refunds that you owe.

HIPAA Q&A: Navigate data sharing, recent HIPAA rules changes

11/04/2024

by: Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI

Question: How should compliance leaders navigate the complexities of data sharing and interoperability initiatives while maintaining strict adherence to HIPAA regulations?

CMS revises Medicare Preventive Services tool

11/04/2024

by: DecisionHealth staff

On October 14, CMS updated its Medicare Preventive Services website with new information on a variety of topics.

Payments rebound, denials tick up for inpatient/obs combo codes

11/04/2024

by: Richard Scott

Part B providers reporting inpatient and observation care codes appeared to face minor but notable headwinds as they adapted to the AMA’s revised reporting guidelines in 2023. Payments increased for some of the oft-reported codes in 2023, but denial rates also crept up for some of the most-billed services.

Use 4 documentation points to square away modifier 25 troubles

10/28/2024

by: Julia Kyles, CPC

Your practice can receive separate payment for an E/M visit on the same day as a minor procedure by using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

Will Fla. ruling mean the end of qui tam? Not right away

10/28/2024

by: Roy Edroso

A federal judge has declared the qui tam (whistleblower) provisions of the False Claims Act (FCA) unconstitutional. This ruling has the potential to end the incentives that drive most FCA prosecutions, including those in health care. Experts have mixed opinions as to how this ruling will play out in higher courts, but even before it’s retried it may affect how such cases are brought and defended.

Home BP readings for ‘white coat hypertension’? OK, but probably not RPM.

10/28/2024

by: Roy Edroso

Question: I have a patient who claims “white coat hypertension” — that is, he says his home blood pressure readings are significantly lower than the ones we get in the office. He has a home BP device, a Pressure X Pro, that connects to the internet. Can I take a reading via this device? And, in addition to adding it compliantly to encounter notes, can I claim 99091 (Collection and interpretation of physiologic data [eg, ECG, blood pressure, glucose monitoring])?

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