Part B News | Part B News

Fake CMS fax scam: Vet faxes like emails; check, then click

07/08/2024

A CMS warning on a “fax phishing” scam reminds you that the noisy little machines are still very much a part of health care and you should train staff to check out the provenance of sensitive faxes as they would sensitive emails.

Be careful of patients seeking Wegovy with suspect heart complaints

07/08/2024

by: Roy Edroso

Question: We have some patients asking questions about Wegovy (semaglutide) coverage. In some instances they apparently want it for weight loss, but suggest they might be suffering from heart trouble in ways that lead us to believe they’re just looking to get it covered by Medicare Part D, which will not pay for it otherwise. Do we need to have a policy for this?

HIPAA Q&A: Secure business associate agreements

07/08/2024

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

Question: How can health care entities ensure their business associate agreements (BAA) fully address the cybersecurity risks and responsibilities related to PHI protection?

Weak pay raises for lower-level clinical staff, especially MAs, RNs

07/08/2024

by: Roy Edroso

A new Medical Group Management Association (MGMA) survey finds that while increased patient volume presents challenges for many practices, pay rates for medical assistants (MA) who can help ease that pressure have only risen slightly in the past year. Over the same period, other clinical and nursing staff did better.

Change Healthcare’s long-delayed breach notice gives providers new footing

07/01/2024

by: Roy Edroso

Four months after an epic hack that affected thousands of provider practices across the country, Change Healthcare started sending breach notifications to covered entities. This offers some assurance to practices that may have felt at sea in the interim — but experts caution they still have work to do.

Walk staff through the intersection of diagnosis coding, medical necessity

07/01/2024

by: Julia Kyles, CPC

Include a refresher on the connection between medical necessity and diagnosis coding when you train your team on the FY2025 update to the ICD-10-CM code set. The Centers for Disease Control and Prevention (CDC) typically releases the final code list in mid- to late June, and will include 250 new codes if the CDC adopts all of the proposed changes.

Cover CPT critical care basics for accurate E/M reporting

07/01/2024

by: Hamilton Lempert, M.D., FACEP, CEDC,

The emergency department (ED) is a demanding setting that challenges coders and providers alike. Information must be synthesized quickly to make life-or-death decisions. Therefore, in a field in which accomplishing thorough documentation can be challenging, representing the rendered services accurately can be even more difficult. To get it right, review the basics of critical care coding and check out common questions coders may have about the topic.

Pinpoint high-rate denials for modifier 25; some E/Ms top the list

07/01/2024

by: Richard Scott

Watch out for turbulence when turning to modifier 25 (Significant, separately identifiable E/M service) for E/M services submitted on the same date as a procedure. Several of the most frequently reported E/M codes, including level one established visit code 99211, garnered double-digit denial rates.

Check your telehealth compliance, align POS codes to avoid costly denials

06/24/2024

by: Julia Kyles, CPC

Double check Medicare’s telehealth services list before you use a telehealth place of service (POS) code on a claim — or risk an automatic denial. A recent change request from CMS serves as a reminder to make sure you’re complying with Medicare’s current telehealth requirements.

Forced to close temporarily? Mind your patient, payment responsibilities

06/24/2024

by: Roy Edroso

If your practice has to temporarily suspend operations for more than a short duration, you may have to approach patients as if the practice were closing for good and provide recommendations for alternative treatment. You may also have to give providers paid on productivity some bad news.

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.