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Practices reported fewer E/M modifiers with office visits after new guidelines

02/05/2024

Providers were less likely to report an E/M modifier with an office/other outpatient visit one year after the new rules for reporting the visits went into effect.

Final prior auth rule sets long lead times — and short payer deadlines

01/29/2024

by: Roy Edroso

With the release of the Interoperability and Prior Authori-zation Final Rule, which CMS dropped on Jan. 17, providers are poised to gain a dose of relief after seeking redress to onerous prior authorization (PA) requirements for years. But it’s not coming as soon as proposed.

Preview updated ICD-10-CM coding guidelines for April 1

01/29/2024

by: Megan Herr

The CDC posted updated FY2024 ICD-10-CM guidelines on Monday, Jan. 22, which included a sequencing update for sepsis due to postprocedural infection.

Use empathy, ‘treatment plans’ to spur provider engagement with compliance

01/29/2024

by: Julia Kyles, CPC

If you struggle to get your compliance message across to physicians and qualified health care professionals (QHP), make sure that you can clearly communicate what you need from the provider and why you need it, and that you do so in a way that make sense to them.

Worried practice buyers will hobble care? Get it in writing during contracting

01/29/2024

by: Roy Edroso

Independent practices that become the target of an acquisition by a larger group or system should take steps to protect their autonomy in the contract stage. A recent survey shows that many physicians employed by large entities are dissatisfied with reduced authority and concerned with the resulting impact on care.

Continue to use the practice address when the place of service is 10

01/29/2024

by: Julia Kyles, CPC

Question: We know the place of service (POS) rules for telehealth services changed this year. Did that change the address we should report in Box 32 of the CMS-1500 form when a patient receives a telehealth visit while at home (POS 10)? We’re not sure if we should use the patient’s home address or continue to report the practice’s address. In addition, our providers occasionally perform telehealth services while they are at home. Which address should we use in that scenario?

CMS drops prior authorization rule, projecting billions in group savings

01/29/2024

by: Richard Scott

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.

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