Despite a flurry of activity and some high-level chatter, the hassle of prior authorization is unlikely to get better anytime soon. But keep an eye open for two possible workarounds: technical solutions that may lower the administrative burden and legal remedies that could shorten the approval timeline.

With a combined denied amount surpassing the $100 million mark in recent years, E/M coding for hospital discharges (99238, 99239) should demand an extra dose of monitoring for errors and a stringent checklist for documentation standards to improve pay streams.

Take heart if you’ve been getting denials this year for therapy evaluations (97161-97172) when reported with one-on-one therapy activities (97530) or group therapy procedures (97150). The National Correct Coding Initiative (CCI) edits that caused those denials have been deleted retroactive to Jan. 1, and you can get reimbursed for the denied claims.

A geriatric practice hires a doctor who has completed her residency, but her Medicare enrollment won’t be approved for at least 30 days. The practice may be tempted to bill the new doctor’s services under a fee-for-time arrangement — Medicare’s current term for locum tenens — but that would violate Medicare billing rules, and a recent fraud settlement shows that it could be a costly violation.

Question: A local candidate for political office wants his medical records from my office and states that he plans to release them to the public and wants his physician to make a statement about his health. Obviously, under HIPAA he has a right to the records, but is it appropriate for the physician to make such a statement?

Currently, CERT auditors may be looking into your use of 99238 (Hospital discharge day management; 30 minutes or less) and 99239 ( … ; more than 30 minutes). If so, it may have to do with their unusual usage pattern relative to other pairs of time-based codes, in which the longer-duration, higher-price 99239 has increased in use while the shorter-duration, lower-price 99238 has declined.

A court ruling has obliterated the HHS guidance that requires your practice to charge third parties the same low price as patients for medical records. You currently don’t have much recourse if the patient just claims the records are for him or her -- but you should prepare yourself for regulation or sub-regulation that may provide it soon.