Part B News | Part B News

FFS Medicare fades, as Medicare Advantage surges in enrollment

04/15/2024

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.

CMS update: Code caregiver training services based on number of patients

04/08/2024

by: Julia Kyles, CPC

Update your staff with the latest information about caregiver training services (CTS) from CMS. A set of frequently asked questions on health-related social needs answers some lingering questions about the CTS for behavior management/modification (96202-96203) and functional performance (97550-97552).

Know full descriptors for caregiver training services

04/08/2024

by: Julia Kyles, CPC

Use the latest guidance from CMS to correctly code caregiver training services. Here are the full descriptors that shed light on your coding and billing designs.

Patient assault underlines need for tight office entry restrictions

04/08/2024

by: Roy Edroso

A recent attack by a man who conned his way into a chiropractor’s office is a reminder to ensure basic security is followed in all cases — and that more than basic security is likely worth the investment.

HCPCS 2024 first quarter update brought nearly 100 changes

04/08/2024

by: Savannah Schmidt

CMS published its HCPCS quarterly update in March, which heralded the sum of 94 HCPCS Level II code additions, discontinuations and definition revisions.

Active status for Category III codes doesn’t lead to active billing

04/08/2024

by: Julia Kyles, CPC

CMS lists most Category III — or temporary — codes as carrier-priced. That means that each Medicare administrative contractor (MAC) will decide whether it will pay for a service on a case-by-case basis. In recent years the agency has granted active status to a few temporary codes, but a look at early Medicare Part B claims data shows that active status doesn’t generate a lot of buzz.

CMS Primary Flex offers $250K, prospective payments to some PCP ACOs

04/01/2024

by: Roy Edroso

CMS’ health equity and primary care missions combine in a new accountable care organization (ACO) demonstration model offering quarter-million-dollar upfront payment to “low revenue” PCPs.

For clean screening claims, review service modifiers GG, PT and 33

04/01/2024

by: DecisionHealth staff

Sections of the Affordable Care Act (ACA) amend the Social Security Act by requiring changes in payment and patient responsibility for deductible and coinsurance/copayments for certain preventive services, such as bone mass measurement, diabetes screening and mammography screenings.

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