Part B News | Part B News

Telehealth expands even more, but will mostly go away unless Congress acts

12/14/2020

In the final rule, CMS cleared dozens of telehealth and telehealth-adjacent codes that nearly all providers can use right now. However, many of them are slated to be removed from general use after the COVID-19 public health emergency (PHE). A few codes, though, are exempt from the traditional telehealth rules.

APP debut, benchmark stasis, small changes mark QPP in PFS

12/14/2020

by: Roy Edroso

Aside from the delay of the MIPS Value Pathways (MVP) and the advance of the APM Performance Pathway (APP), the adjustments to the Quality Payment Program (QPP) and the Merit-Based Incentive Payment System (MIPS) do not veer too far from previous versions of the program. Yet experts warn that even minor changes can have a big impact on your performance.

Shared Savings gets routed into APP, but keeps Web Interface for one more year

12/14/2020

by: Roy Edroso

The Quality Payment Program (QPP) portion of the final 2021 Medicare physician fee schedule undergoes one major change — a new quality reporting method with both upsides and downsides — but participating accountable care organizations (ACO) get to hang onto the Web Interface option for one more year.

Fees and payment indicators complete the picture for new codes

12/14/2020

by: Julia Kyles

Take a look at the final payment determinations for codes that will go into effect Jan. 1, 2021. The list includes 39 codes that were previewed in the proposed 2021 Medicare physician fee schedule and four codes CMS created in the interim, including the replacement prolonged service code (G2212) and the extended virtual check-in code (G2252).

CMS finalizes MDPP changes; program all-virtual until the PHE ends

12/14/2020

by: Roy Edroso

Changes proposed to sustain the Medicare Diabetes Prevention Program (MDPP) as COVID-19 distancing makes in-person sessions problematic are implemented in the new physician fee schedule final rule — but note some rule changes for participants who start after Jan. 1, 2021.

2021 Part B fee projections: Top specialties adding – and losing – revenue

12/14/2020

by: Richard Scott

It’s a topsy-turvy fee outlook in 2021, as medical practices are projected to see wild fluctuations in Part B charges in the new year. With specialty-specific gains reaching as high as 16% – and losses also reaching double digits – your billing patterns are likely to tell how your Medicare charges will fare.

Wave of federal risk adjustment investigations reveals pain points for providers

12/07/2020

by: Roy Edroso

Recent high-profile investigations of Medicare Advantage organizations (MAO) suggest that, as the program grows, investigators and auditors are getting more attentive to risk adjustment irregularities — and that this attention may eventually reach down to contracted providers.

The 3 elements of MDM: Get to know the refurbished ‘risk of complications’ category

12/07/2020

by: Laura Evans, CPC

To help subscribers prepare for the 2021 E/M office visit guidelines, Part B News will examine each of the three elements of medical decision-making (MDM) and how they will change starting Jan. 1. This issue previews the “risk of complications and/or morbidity or mortality of patient management.”

Telehealth update: Make sure to lock in medical necessity before billing phone E/Ms

12/07/2020

by: Laura Evans, CPC

While it’s true that Medicare is covering E/M visits performed via the telephone (codes 99441-99443) on a temporary basis during the public health emergency (PHE), practices should not take this as license to bill their patient phone calls as E/M visits, coding experts warn.

No, your EHR is not to blame for documentation or coding errors

12/07/2020

by: Julia Kyles, CPC

You’re not alone if you worry that your electronic health record (EHR) might create liability issues, but you will need to work with the vendor to change the system or create your own work-arounds to protect your practice.

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