Part B News | Part B News

Prepare: New DOJ pilot pushes non-FCA fraud reporting, with an online form

08/26/2024

A new whistleblower pilot threatens to “supercharge” the range of qui tam suits brought against health care entities. Confer with your business insurers, counsel and compliance officers to prepare.

Find insights on HIPAA final rule on reproductive health care privacy

08/26/2024

by: Dom Nicastro

The final rule “HIPAA Privacy Rule to Support Reproductive Health Care Privacy“ aims to safeguard sensitive protected health information (PHI) in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. This landmark ruling has far-reaching implications, particularly in states with restrictive reproductive health laws, prompting a critical need for enhanced privacy protections.

Modifier 78 continues its slide, though most codes have 0% denials

08/26/2024

by: Roy Edroso

The Medicare billing numbers show a precipitous pandemic-era drop in utilization of modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period). You may have expected that losing trend to slow as America began to recover from the pandemic in 2022. It did, but not by much. The total number of 78 citations slid from 65,857 in 2021 to 51,177 in 2022, a 22% loss.

Include Oct.-effective excludes note updates in your diagnosis education

08/19/2024

by: Julia Kyles, CPC

Include training on the new ICD-10-CM excludes notes before the next update goes into effect on Oct. 1. The new tabular addenda for the FY2025 code set contains 18 new and eight deleted Excludes1 notes.

Proposed digital therapy codes good idea with barriers: Experts

08/19/2024

by: Roy Edroso

Experts say the latest Medicare innovations in behavioral health, including one that would pay for patients to use “digital therapies” such as apps, are sensible and welcome. But it remains to be seen how quickly these services would reach the beneficiaries who need it.

CMS revamps place of service for depression screening services

08/19/2024

by: Julia Kyles, CPC

Take note of pending billing changes for Medicare’s depression screening service G0444 (Annual depression screening, 5 to 15 minutes).

Stick with CMS’ prolonged service times for office/outpatient visits

08/19/2024

by: Julia Kyles, CPC

Question: CMS’ prolonged service code G2212 was originally based on the maximum times in the descriptors for codes 99205 and 99215. But the 2024 CPT manual replaced the minimum and maximum time ranges for the office/other outpatient codes with minimum times that the provider must meet or exceed.

Should our practitioners continue to use Medicare’s prolonged service times for office/other outpatient E/M visits, or should they switch to the shorter times for prolonged service code 99417 in the 2024 CPT manual?

Look for these attributes in your top security officer

08/19/2024

by: Julia Huddleston, CIPP/US, CIPM, CCSFP

Question: We are hiring a chief information security officer (CISO). What are the top traits and skills they should have?

Primary Care ACO deadline pushed back

08/19/2024

by: Roy Edroso

The Center for Medicare and Medicaid Innovation (CMMI) announced on July 24 that the deadline for submitting an application for the Primary

Care Flex Model accountable care organization model (ACO) would be moved from Aug. 1, 2024, to Aug. 23, 2024.

E/M aches and pains: Just 2 codes would see fee rise in ’25

08/19/2024

by: Richard Scott

The outlook is bleak for most of the 101 E/M codes (99202-99498) available for billing under Medicare Part B in 2025. Just two codes in the E/M series are on track to see a positive shift in reimbursement, and one of those gainers is up a scant $0.03 year-to-year, according to an analysis of the proposed 2025 Medicare physician fee schedule.

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