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10/11/2021
It looks as if providers have cut way back on their use of modifier 78 (Unplanned return to the operating room by the same physician fol-lowing initial procedure for a related procedure during the postoperative period). In 2019, the modifier appeared on a mere 94,255 claims, a major drop from 2015, when it was claimed more than 531,000 times.
10/04/2021
Between the COVID-induced expansion of telehealth and the emerging set of tools patients have to communicate with providers, now’s the time to assess how the virtual elements of health care are affecting patient expectations and providers’ stress levels. Experts urge a watchful eye, and a policy to meet the tech age without major disruption.
10/04/2021
Medicare advantage (MA) chart reviews may be irritating, but when a reviewer asks your practitioners to sign medical record addendum (MRA) forms, a desire to get it over with or a fear of retaliation by an MA plan aren’t valid reasons to sign. You must make sure the addendum is on the up-and-up or face stiff consequences.
10/04/2021
The delicensure of a physician in Oregon who counseled patients against wearing masks shows that giving advice to patients that conflicts with accepted medical standards may subject health care workers to penalties, including the inability to practice medicine.
10/04/2021
Question: The 2022 ICD-10-CM code set includes a new code, U09.9 (Post-COVID-19 condition, unspecified), for post-COVID-19 conditions. When would it be appropriate to report this code?
10/04/2021
The manipulation of chart reviews and the vendor-led increase of in-home health risk assessments (HRA) may be inflating diagnosis coding levels, and be warned: The OIG and other federal groups are closely monitoring the activity.
09/27/2021
A $3 million settlement of False Claims Act charges stemming from inappropriate use of the modifiers 25 (Significant, separately identifiable E/M service), 59 (Distinct procedural service) and XU (Unusual non-overlapping service) is a warning to keep an eye on habitual use of these modifiers that allow extra charges during patient encounters.
09/27/2021
Monitor the public comments and activity around a series of recent federal rules, and you may gain an early glimpse of regulatory updates coming your way. Recently, comments closed on the proposed 2022 Medicare physician fee schedule, revealing major concerns of medical organizations and other stakeholders; and, in separate updates, CMS issued a new rule related to the No Surprises Act and changed course on how to make “breakthrough technology” available to patients.
09/27/2021
If your practice has indirect compensation arrangements (ICA) with hospitals, labs or other designated health service providers, you may need to revisit those agreements. CMS is proposing to update the Stark physician self-referral rule to make more ICAs subject to Stark’s requirements.
09/27/2021
Question: My doctor had a telehealth visit with a 75-year-old patient who has well-controlled diabetes and mild cognitive decline. A week later, with the patient’s permission, the physician gave the patient’s adult daughter an update on her father’s health. The conversation took place through Zoom and lasted 23 minutes. The patient wasn’t present. Can we bill the conversation to Medicare as an E/M visit (99202-99215) under the special rules for telehealth services or, alternatively, the new E/ M guidelines?

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