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CMS drops prior authorization rule, projecting billions in group savings

01/29/2024

After CMS finalized a regulatory path for easing the burden of prior authorizations, the agency offers some bullish projections on financial savings: Under the rule, individual and group physician practices would save $1.2 billion in the first year of implementation and more than $16 billion over 10 years.

No Surprises IDR portal is back; prepare for new info requirements

01/22/2024

by: Roy Edroso

After a long delay, the independent dispute resolution (IDR) process for providers engaged in No Surprises Act conflicts with payers came back online in December. But there are other changes - some live now, some coming soon Ñ that you’ll want to know about in case you need to use it.

CMS throws a copay curveball for the SDOH risk assessment

01/22/2024

by: Julia Kyles, CPC

Prepare your schedulers and billers for questions about the copay for G0136 (Administration of a standardized, evidence-based social determinants of health [SDOH] risk assessment tool, 5-15 minutes, not more often than every 6 months).

2024 NCCI manual updates include new guidance and examples

01/22/2024

by: Savannah Schmidt

The National Correct Coding Initiative (NCCI) released the 2024 NCCI Policy Manual in early December, effective January 1. In addition to more substantive changes from its 2023 counterpart, numerous changes included general word choice updates that appear throughout the manual.

Adhere to rules on reporting RTM or RPM during the global period

01/22/2024

by: Laura Evans, CPC

Question: I interpret recent CMS rulemaking that the RTM codes (98975, 98977, 98980 and 98981) are bundled in the global period if they are being performed for the same diagnosis and by the same provider who did the surgery. Am I reading that correctly?

Identify proper use of separate-structure modifier XS

01/22/2024

by: Savannah Schmidt

Question: A physician debrides a hyperkeratotic lesion on a patient’s left foot, second toe. During the same encounter, he performs a debridement of the five toenails. Which CPT codes and modifiers would be reported for this procedure?

Subsequent AWVs continue flying, but initial AWV, IPPE stay grounded

01/22/2024

by: Roy Edroso

Regular comprehensive exams are among the few services for which all Medicare beneficiaries are eligible. While initial preventive physical examinations (IPPE) and initial annual wellness visits (AWV) remain mired in their pandemic-era utilization numbers, subsequent AWVs continue a strong recovery.

CPT errata folds interprofessional consults into same-day E/M visits

01/15/2024

by: Julia Kyles, CPC

Flag this update in your 2024 CPT Manual, alert staff and double-check your claims for interprofessional consult requests: The CPT editorial panel issued a late-breaking correction to the guidelines for 99452 (Interprofessional telephone/Internet/electronic health record referral service[s] provided by a treating/requesting physician or other qualified health care professional, 30 minutes). The correction went into effect Jan. 1, 2024.

Health care VR growth slow in reimbursement, quicker as a teaching tool

01/15/2024

by: Roy Edroso

Virtual reality (VR) is advancing as a health care tool -- though, experts agree, not yet as a reimbursable service on its own. In the short run its greater impact will likely be felt in physician training, particularly when new technology that adds tactile functions to it comes of age.

Give providers an illustrated guide to the new SDOH risk assessment code

01/15/2024

by: Julia Kyles, CPC

Make sure your physicians and qualified health care professionals (QHP) are ready for their crucial role in reporting G0136 (Administration of a standardized, evidence-based Social Determinants of Health [SDOH] Risk Assessment tool, 5-15 minutes, not more often than every 6 months).

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