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

04/08/2024

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.

Use AI to scribe? Pay attention to data privacy, ownership

04/01/2024

by: Roy Edroso

Much discussion of artificial intelligence (AI) in health care focuses on the readiness, or lack thereof, of clinical applications. But even if you’re using only the most basic AI tools, such as scribing applications, you still need to be careful about data security, integrity and privacy — and about the contract terms that allow the vendor to use your data.

MACs take another crack at the uniform LCD for facet joint interventions

04/01/2024

by: Julia Kyles, CPC

Get ready for another update to your local coverage determination (LCD) for facet joint interventions. Medicare administrative contractors (MAC) are teaming up again to clarify their uniform LCD for facet joint nerve blocks (64490-64491 and 64493-64494) and radiofrequency ablation (RFA) (64633-64636).

Lesion-destruction codes top list of 59-appended services; labs lose

04/01/2024

by: Richard Scott

For the second year running, providers turned to modifier 59 (Distinct procedural service) most often when performing a lesion-destruction service, and denials held steady for codes 17003 and 17000. But keep an eye on a duo of lab codes: the denial rates on 87798 and 87481 shot up significantly in 2022.

Spending bill boosts Medicare conversion factor, but advocates seek more

03/25/2024

by: Roy Edroso and Julia Kyles

The stopgap 2024 Consolidated Appropriations Act (CAA) upped the Part B conversion factor, but delivered what many health care industry groups consider insufficient relief to physicians suffering from Medicare cuts.

First HIPAA settlement for phishing attack highlights critical cybersecurity management

03/25/2024

by: Dom Nicastro

The Office for Civil Rights (OCR) announced in December a significant settlement with Lafourche Medical Group, marking the first resolution of an investigation into a phishing cyberattack under HIPAA. Understand key compliance strategies with the following question-and-answer session with Omer Kaan Aslim, cybersecurity specialist at cybersecurity firm Lake Ridge, who shares compliance tips related to this breach.

MACs accidentally cut pay for telehealth in the patient’s home

03/25/2024

by: Julia Kyles, CPC

Check your payments for telehealth services reported with place of service 10 (Telehealth provided in patient’s home) after Jan. 1, 2024. If your Medicare administrative contractor (MAC) paid the facility rate that’s a big mistake. Your MAC should pay the non-facility rate when the patient is at home during a telehealth service.

Heed definitions, dx requirements in new trigger point injection LCD

03/25/2024

by: Julia Kyles, CPC

Question: We have three follow-up questions about the new local coverage determination (LCD) for trigger point injections (20552-20553) that will take effect on April 1.

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