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APMs, QPs and groups gain, virtual groups vanish in Quality Payment Program Report

07/20/2020

CMS’ 2018 Quality Payment Program (QPP) Experience Report that came out on July 7 suggests that Alternative Payment Models (APMs) are slowly gaining on traditional individual and group reporters — and virtual groups are washing out.

Final 2021 ICD-10-CM update confirms hundreds of codes, including fractures, CKD and COVID-19

07/13/2020

by: DecisionHealth staff

You can plan to see nearly 500 codes — including the two new U codes for COVID-19 and vaping-related disorders — added to the ICD-10 code set this year.

Latest Section 1557 rule rescinds trans patients’ rights, but SCOTUS has other ideas

07/13/2020

by: Roy Edroso

HHS finalized the Section 1557 final rule last month, which would seem to remove civil rights protections for trans or non-binary patients seeking federal payer coverage for treatment. But other events, including a recent Supreme Court decision, suggest that little has changed for providers as far as discrimination against such patients is concerned, and you should proceed as if it has not.

Avoid duplicating time if you opt to report split/shared office visits in 2021

07/13/2020

by: Julia Kyles, CPC

Keep a calculator handy if your practice opts to report E/M office visits based on time next year. Activities that can be counted include reviewing a patient’s test results, performing an examination and communicating with other health care professionals about the patient’s care.

Dive into ONC ‘playbook’ to help guide your practice’s use of health IT

07/13/2020

by: Marla Durben Hirsch

Review and update your practice’s policies for the use of electronic health records (EHR) and other health information technology (IT). The Office of the National Coordinator for health IT (ONC) released new guidance this year on how to make the most of these investments.

Master remote physiologic monitoring elements, rules to ensure clean coding

07/13/2020

by: Julia Kyles, CPC

With the recent addition of new services, practices have more ways to get paid to keep tabs on patients’ physiologic data when the patient is in a remote location. However, the services have a confusing variety of requirements.

You can append modifiers 50 and 51 to same code but check MAC policy

07/13/2020

by: Laura Evans, CPC

Question: Do you have any resources that specifically state whether modifiers 50 (Bilateral procedure) and 51 (Multiple procedures) could or should be applied on the same claim line? Our institution requests that coders apply modifier 51 for RVU allocation. It seems odd to increase the charge to 150% and also apply a 50% reduction in RVU to make it 75% the total value, if that makes sense.

AMA issues 3 new COVID lab codes, including a nasal swab assay

07/13/2020

by: Laura Evans, CPC

The AMA on June 25 issued three new CPT clinical lab codes — a new Category I microbiology code and two new proprietary “U” codes — to test patients for COVID-19.

Multiple procedures on same DOS clear payment systems with few denials

07/13/2020

by: Richard Scott

Getting paid for more than one procedure on the same date of service was not much of a challenge for providers in recent years, judging by the claims data on modifier 51 (Multiple procedures).

Boost training, revise forms and ping vendors to avoid disruptions before E/M switchover

07/06/2020

by: Julia Kyles

Look to your office processes and fire up your staff training before the new E/M coding guidelines take effect Jan. 1, 2021. If everyone in the practice has plenty of time to prepare, you can help ensure a smooth switch to the new guidelines without disrupting your practice’s revenue cycle.

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