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Doc running for office? Get schedule, contract, outreach sorted out first

02/19/2024

If your physicians get involved in electoral politics, a former and current contender warns there are a few steps they need to take care of before tossing their hat in the ring, particularly when it comes to how the practice will carry on without them.

CMS releases HCPCS Level II updates including 36 new codes, effective April 1

02/19/2024

by: Savannah Schmidt

CMS published a summary of its fourth quarter 2023 HCPCS Level II code update application decisions to its website January 30. The agency made a total of 58 changes with 36 added codes, four revised codes, and 18 deleted codes. The additional and revised codes mostly consist of injections, medications and skin substitutes. The codes and their respective effective dates are listed below.

Choose the correct modifier for multiple encounters on same DOS

02/19/2024

by: Savannah Schmidt

Question: A patient underwent a diagnostic nasal endoscopy at 10 a.m. At 7 p.m., the patient developed an epistaxis and the physician had to use some complex cauterizing techniques to control the nosebleed. How would the physician’s services in this scenario be reported?

HHS audit uncovers raft of overpayments for E/M services

02/19/2024

by: Richard Scott

Shore up your documentation and strengthen your coding accuracy to ensure your claims aren’t falling into incorrect or fraudulent territory. The Comprehensive Error Rate Testing program under HHS found more than $3.7 billion in improper payments made to a series of E/M services, including more than $660 million in errors for a single E/M office visit code (99214).

Growth in outpatient programs signals opportunities for MFTs, MHCs

02/12/2024

by: Roy Edroso

Marriage and family therapists (MFT) and mental health counselors (MHC), the newest providers empowered to enroll in and be reimbursed by Medicare, have an opportunity to participate in a new CMS program. This could lure more of these providers into Medicare, making them available for partnership in Part B behavioral health.

Separate fact from fiction when you train staff to use G2211

02/12/2024

by: Julia Kyles, CPC

Interest in the visit complexity code (G2211) is high, according to questions that CMS officials received during a recent open door forum (PBN 2/5/24). But so is confusion about the service. Your practice could miss revenue opportunities and trigger denials if your staff can’t tell coding fact from coding fiction.

Look to HHS reports to monitor weak spots, boost cybersecurity efforts

02/12/2024

by: Dom Nicastro

HHS released two reports recently that provide in-depth insights and compliance tips to help health care covered entities contend with cybersecurity threats.

How to handle payer requirements that conflict with AMA guidelines

02/12/2024

by: Julia Kyles, CPC

Question: According to one of our private carriers there are two possible ways we should report bilateral services with modifier 50 (Bilateral procedure):

Report modifier 50 on two service lines with one unit each.
Report modifier 50 on one service line with 2 units of service.

However, the carrier does not have this in their payment policies. In addition, this private payer’s instruction contradicts other private carriers and our Medicare administrative contractor (MAC). What should we do?

Break in 2024 ICD-10-CM osteoporosis fracture codes

02/12/2024

by: Savannah Schmidt

The 2024 ICD-10-CM update added 36 codes to the now nearly 400 codes in category M80.- (Osteoporosis with current pathological fracture). Incorporate the additional codes into your routine, as they add further specificity for pelvis fractures due to age-related osteoporosis.

Top screening codes creep back to pre-PHE levels, but slowly

02/12/2024

by: Roy Edroso

The most-used Medicare screening services took a tumble in 2020, the first year of the COVID-19 public health emergency, and seemed to be staging a comeback in 2021. The most recent available figures, however, suggest any comeback is leveling off.

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