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11/09/2020

On Oct. 29, CMS announced a final rule on transparency coverage requiring insurers to provide accurate prices for health care procedures.

COVID vaccine, therapeutics rule issued

11/09/2020

by: Roy Edroso

On Oct. 28, HHS announced an interim final rule with request for comments. The rule, issued by HHS, the U.S. Departments of Labor and the Treasury and the IRS, calls for all health care payers to offer a COVID-19 vaccine, when it becomes available via FDA authorization, as a Medicare preventive vaccine without cost-sharing.

Review advance care planning charts before OIG starts its audit

11/09/2020

by: Julia Kyles, CPC

Check the time and other possible billing hazards for advance care planning (ACP) claims. The two ACP codes (99497, 99498) show an average denial rate of 19% since Medicare started covering the service, which may be a sign that practices are making easy-to-avoid mistakes for the two codes.

Booming interest in behavioral health integration signals a new opportunity for practices

11/02/2020

by: Roy Edroso

A new multi-organizational collaborative is proving further evidence of the growing interest in behavioral health integration (BHI) with primary care. While reimbursement for integration is unsteady at present, signs suggest this will become a larger and better compensated part of your practice in the years to come — if you’re prepared to implement it.

Tackle CPT coding challenges and ICD-10-CM updates for behavioral health

11/02/2020

by: Sarah Gould

Get a crash course on coding for behavioral health services, which can be tricky given number of conditions that influence mental well-being. Providers must tailor evaluations and interventions to individual needs and adhere to medical necessity standards when billing for services under Medicare.

Narrow your focus: Even if you meet the NCD, missing LCD could cost you

11/02/2020

by: Roy Edroso

A recent OIG investigation, and over $300,000 in potential paybacks, serves as a reminder to check your local as well as your national coverage determination (NCD) before performing and billing Medicare for bariatric weight-loss surgery — or anything else.

4 key questions to prepare for the changing rules of prolonged services

11/02/2020

by: Julia Kyles, CPC

When you train staff on the new rules for prolonged service codes, it’s imperative to know how to accurately capture time spent on an encounter and how to prepare for new guidance in 2021.

Payments, claims flow forth for lucrative psychiatric diagnostic codes

11/02/2020

by: Richard Scott

Provider payments for two psychiatric diagnostic evaluation codes (90791, 90792) maintained steady growth in recent years, returning more than $140 million in fees in 2018, the latest year of available Medicare claims data.

If SCOTUS kills ACA, prepare for uninsured patients till states, Congress act

10/26/2020

by: Roy Edroso

The Supreme Court is again weighing the fate of the Affordable Care Act (ACA) in California v. Texas, and the odds on its repeal seem higher than ever. Some experts think the ACA still has a good chance of surviving. But if all or part of it falls, even many of your non-exchange patients will have to rely on lawmakers to pick up the slack.

Audio-only services, E/M documentation updates major focus of PFS comments

10/26/2020

by: Richard Scott

Various stakeholders are calling on CMS to maintain the current payment rates for audio-only E/M services after the COVID-19 public health emergency (PHE) ends, and others want to see a permanent removal of telehealth restrictions.

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