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Hybrid providers: Keep using your office address, watch for new rules

04/22/2024

CMS’ new National Plan and Provider Enumeration System (NPPES) policy is limited to individual providers — typically telehealth providers — who only work from home (see story on this page). The address exception is not an option for hybrid providers, such as those who are currently offering telehealth services under the telehealth waiver extension.

Measles in your office? Follow CDC rules, take caution in telling patients

04/22/2024

by: Roy Edroso

With serious diseases spreading in some communities, now is a critical time to review your responsibilities if a person infected with a rare illness comes through your office, and how you should interact with your health care providers and other personnel.

Lack of behavioral health providers in Medicare and Medicaid impedes enrollees’ access to care

04/22/2024

by: Part B News staff

On April 3, the OIG published a report on how low behavioral health provider participation in Medicare and Medicaid impacts enrollees’ access to care.

X-tra special: 59-alternative X modifiers dial back the denials

04/22/2024

by: Richard Scott

When practices turn to a substitute for modifier 59 (Distinct procedural service), two options from the series of Medicare-approved X[EPSU] modifiers stand high above the rest, and in most cases the claims-approval rates are superior.

MAC demand: Medical necessity controls coverage of preop E/M visits

04/15/2024

by: Julia Kyles, CPC

Pay close attention to medical necessity when a provider schedules a patient for a preoperative visit and you code the E/M visit. Even though a hospital may require preoperative clearance for surgery patients, Medicare controls whether it will pay for the visits. Surgeons may have more leeway than specialists when they perform certain preoperative visits, but they must still support medical necessity to protect their patients from an unexpected bill and the practice from unexpected denials.

Medicare Advantage rate rise miffs payers; blowback should be minor

04/15/2024

by: Roy Edroso

On April 2, CMS approved a final average 3.7% increase on the Medicare Advantage base rate for 2025, an adjustment Medicare Advantage organizations (MAO) and the insurers who run them found disappointing. While some advocates have suggested these plans will pull back on benefits, large changes are not expected in the short run.

HIPAA Q&A: Watch cybersecurity frameworks, health apps, texts

04/15/2024

by: Dom Nicastro

In this week’s issue, Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI, HIPAA security and privacy training expert and CEO of Privacy & Security Brainiacs SaaS services, answers a range of questions about cybersecurity efforts, HIPAA compliance in health apps and much more.

FFS Medicare fades, as Medicare Advantage surges in enrollment

04/15/2024

by: Roy Edroso

The most recent CMS numbers show Medicare Advantage enrollment continuing to outpace traditional Medicare, and some measures suggest Part C has already beat fee-for-service Medicare to become the majority Medicare insurer.

Time out: Encourage compliance with a stay of enrollment review

04/08/2024

by: Julia Kyles, CPC

Use Medicare’s new “stay of enrollment” rule to warn your staff: CMS’ easier option for non-compliance is still hard on the practice’s finances.

CMS’ loans for Change Healthcare hack may not be worth it: Expert

04/08/2024

by: Roy Edroso

Both CMS and UnitedHealth Group (UHG) have offered cash loans to practices impacted by the recent Change Healthcare hack. But an industry expert cautions that the CMS package might not be your best course of action.

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