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Many low-billing injections, some big-ticket codes in top locum tenens claims

09/23/2024

The number of claims filed in 2022 with the locum tenens modifier Q6, appended when a substitute provider is practicing under Medicare locum tenens rules, was 3.2 million, a 15% increase from the 2.8 million claims in 2021. Maybe in the last year of the COVID-19 public health emergency, more providers were taking vacations.

As practice bankruptcies surge, watch your financial ins and outs

09/16/2024

by: Roy Edroso

New analysis shows a significant spike in physician practice bankruptcies in recent months, which experts attribute to a number of financial headwinds. While you may not be on the path to Chapter 11 at the moment, it’s worth a second look at the factors that can lead to it.

Protect patients: Help local pharmacies prepare for the HIV PrEP NCD

09/16/2024

by: Julia Kyles, CPC

Work with pharmacists to make sure patients who receive antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection prevention don’t miss a treatment when CMS implements the national coverage determination (NCD) for a new preventive service that includes pre-exposure prophylaxis (PrEP) for HIV.

Check new flu shot prices; some patients may lack other vax coverage

09/16/2024

by: Roy Edroso

The arrival of flu season brings a new reason for patient encounters. When patients come in for the shot -- and others they may want at the same time -- make sure you and they understand the current coverage and cost.

Part II: Heed lessons from high-dollar Security Rule settlement

09/16/2024

by: Dom Nicastro

Organizations should adopt a proactive approach to updating their policies and procedures and stay ahead of regulatory changes and emerging threats. At minimum, they should schedule annual reviews of policies and procedures, updating them as necessary to reflect shifts in regulations, according to Maha Shahid, content specialist at CureMD and a provider specializing in IT health care solutions.

Avoid cloning mistakes, spruce up documentation to avoid ED bruises

09/16/2024

by: Son Hoang

It can be especially challenging to thoroughly document rendered services in the emergency department (ED) due to the unique needs of the setting. Due to the life-or-death situations often present in the ED, clinicians and coders are at risk of failing to document essential information.

Bankruptcies rise among physician practices, bucking the trend

09/16/2024

by: Richard Scott

While the year is not yet out, bankruptcies are hitting the medical practice business harder in 2024 than they did in 2023, climbing a substantial 60% year to year.

Appeals court supports TMA against No Surprises rule

09/16/2024

by: Roy Edroso

A rule based on the No Surprises Act was again handed a legal defeat, this time by the Fifth Circuit Court of Appeals, on August 2. HHS, along with the U.S. Departments of Labor and the Treasury, had appealed last year’s decision in U.S. District Court for the Eastern District of Texas that suspended CMS’ independent dispute resolution process (IDR) by which “surprise billing” of out-of-network claims were adjudicated.

Non-compete rule blocked; watch other forces on restrictive covenants

09/09/2024

by: Roy Edroso

A court has blocked the Federal Trade Commission’s (FTC) noncompete rule that threatened to invalidate contract terms many physician practices rely on to prevent patient poaching. But don’t get too comfortable yet; there are still common and state law standards that can complicate the use of non-competes.

Commenters ask CMS to expand the SDOH risk assessment

09/09/2024

by: Julia Kyles, CPC

CMS issued a broad request for information on the new codes that it created this year to address social needs, including G0136 (Administration of a standardized, evidence-based social determinants of health risk assessment [SDOHRA] tool, 5-15 minutes, no more than once every 6 months). CMS wants “to engage interested parties on additional policy refinements for CMS to consider in future rulemaking,” according to the proposed 2025 Medicare physician fee schedule.

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