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Under Section 1557 final rule, nondiscrimination mandates are coming soon

06/10/2024

The finalization of the Section 1557 rule from HHS’ Office for Civil Rights (OCR) means that practices will have to take practical steps — including training staff and designating a 1557 “coordinator” — with urgency, as the rule has an effective date of July 5 and tight deadlines.

CMS clarifies signature requirements for MACs and other auditors

06/10/2024

by: Julia Kyles, CPC

Make sure staff who handle audit requests understand when a missing signature should — or should not — trigger an automatic denial of your claims or prior authorization requests. Recent guidance from CMS clarifies how auditors should proceed when a medical record lacks a signature. CMS also removed its famous signature chart from its guidance.

Improve trigger point injection coding with a specialist’s tips

06/10/2024

by: Julia Kyles, CPC

Boost your staff’s trigger point injection coding (20552-20553) knowledge by adding clinical trigger point facts to your next training session.

Expert: SDOH assessment needs follow-through beyond documentation

06/10/2024

by: Roy Edroso

CMS continues to expand its use of social determinants of health (SDOH) in Medicare. Recently the agency made a manual change making an SDOH assessment a payable add-on service with the Medicare annual wellness visit (AWV). If the provider taking the assessment finds the patient has social issues that should be addressed, you have an obligation to go beyond documenting it.

1 to 2 muscle trigger point injections fall 33% in 5 years

06/10/2024

by: Richard Scott

The rates of administering trigger point injections (TPI) have dropped dramatically in recent years, and providers have witnessed an associated revenue shortfall for the two primary TPI codes used for pain management.

MACs warn of 4 billing company behaviors that could harm your practice

06/03/2024

by: Julia Kyles, CPC

Hiring the right third-party billing company can improve your revenue and reduce compliance headaches for your practice. Hiring the wrong company can mean your practice is responsible for behavior that aggravates your Medicare administrative contractor (MAC), could result in negative consequences for your practice, and the billing company might even charge you extra for the problems it is creating.

Stick to documentation requirements for wound sizing in CPT

06/03/2024

by: Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC

Question: Do you have any advice for encouraging providers to improve documentation for wound sizing in CPT?

QPP reports show MIPS fading as groups pivot to APM models

06/03/2024

by: Roy Edroso

The latest CMS reports on the Quality Payment Program (QPP) suggest that participation in the Merit-based Incentive Payment System (MIPS), while still favored by most participants, is declining as participation in the Advanced Alternative Payment Model (Advanced APM) path grows.

Part II: Expert Q&A covers NIST Cybersecurity Resource Guide

06/03/2024

by: Dom Nicastro

The National Institute of Standards and Technology (NIST) published NIST SP 800-66 Rev. 2 in February. You can turn to the publication to gain practical guidance and to safeguard health information and better understand the security concepts discussed in the HIPAA Security Rule including for business associates (BA) and covered entities (CE). The Q&A continues below.

Small practice MIPS reporting methods explained

06/03/2024

by: Julia Kyles, CPC

Small practices favored group reporting over individual and virtual group reporting methods during the 2022 Quality Payment Program (QPP) reporting period. Here is how CMS defines the different reporting methods, according to the 2022 QPP Public Use File Data Dictionary.

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