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Be proactive about discrimination support – or risk liability

12/18/2023

If an employee has a discrimination issue, whether it’s reported or unreported, don’t try to “wing it.” Instead, have a process in place that makes sure both the employee and the practice are protected — and invite employees to use it.

3 Q&As: Manage coding errors, burnish documentation, code from reports

12/18/2023

by: Julia Kyles, CPC

The following series of questions and answers deliver key coding and documentation guidance on various sce-narios you may encounter in your day-to-day operations. All Q&As took place during the Advanced Specialty Coding Summit — Anesthesia, a DecisionHealth virtual event that took place in November.

5-minute interprofessional consult code maintains strong growth

12/18/2023

by: Richard Scott

Most of the interprofessional consultation services that saw a spike in claims during the initial COVID wave returned to lower utilization, except for a glaring outlier: the most-reported interprofessional consult code 99451 continues its surging growth trajectory.

New compliance guidance makes it easier for practices to think small

12/11/2023

by: Julia Kyles, CPC

The HHS Office of Inspector General (OIG) is making good on its April 24 announcement that it will modernize its compliance programs. The agency published the General Compliance Program Guidance (GCPG) on Nov. 6, 15 years after the OIG’s last model compliance plan, a supplemental guideline for nursing facilities.

Thwart abuse: Consider opt-out, training in chaperone policy

12/11/2023

by: Roy Edroso

Some notable recent cases in which providers have been accused of sexual assaults on patients in exam rooms present an occasion to reconsider medical chaperone policies that can help defend against such incidents.

CMS will cover caregiver training for behavioral and functional care

12/11/2023

by: Julia Kyles, CPC

Medicare finalized coverage of five caregiver training codes, effective Jan. 1, 2024. The decision paves the way for reimbursement when a provider such as a physical therapist, physician or physician assistant trains a patient’s friend or family member to provide behavior management or modification (96202-96203) or to improve a patient’s ability to perform activities of daily living (ADL) (97550-97552) when the patient is not present.

Before dismissing intoxicated patient, try to see beyond to root cause

12/11/2023

by: Roy Edroso

You may occasionally encounter a patient who, in the provider’s opinion, is intoxicated, either by drugs or alcohol. Given informed consent issues, you may be inclined to refuse treatment -- but be careful that you’re not missing a chance to throw the patient a lifeline.

Social determinants of health assessment tools must cover 4 core domains

12/11/2023

by: Julia Kyles, CPC

Question: I am looking for more specific information on code 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).

PFS pain for 2024 selected codes is spread out, but still hurts

12/11/2023

by: Roy Edroso

With a 3.4% conversion factor (CF) cut looming in 2024 and Congress looking less likely by the day to deliver timely relief, providers who routinely bill services from CMS’ “selected codes” chart can at least take comfort that none of the 23 non-facility codes are taking too big a loss.

Physician regulatory burden persists; likelihood of relief spotty

12/04/2023

by: Roy Edroso

A new survey of health care executives finds them at least as bothered by regulatory burdens such as prior authorization and QPP/MIPS as they’ve ever been. While modest reforms are coming to prior auth, however, the status quo isn’t likely to change in the near future.

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