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CMS releases revised guidance for Medicare drug price negotiation program

07/17/2023

On June 30, CMS published Revised Guidance regarding the Medicare Drug Price Negotiation Program in which CMS will negotiate with drug manufacturers to set maximum fair prices for certain high-expenditure, single-source drugs without generic or biosimilar alternatives.

Claims with OR-return modifier 78 drop 25% in one year

07/17/2023

by: Roy Edroso

The years-long decline in claims with modifier 78 (Unplanned return to the operating room by the same physician following initial procedure for a related procedure during the postoperative period) was accelerated by the pandemic in 2020. This downward trend appears to have continued in 2021: The total number of claims made with 78 dropped precipitously, from 87,826 in 2020 to 65,857 in 2021, a decline of 25%.

Get to the point: MACs meet to pin down trigger point injections

07/10/2023

by: Julia Kyles, CPC

Medicare administrative contractors (MAC) took a step that could lead to a uniform policy for trigger point injections (TPI) during a joint meeting on April 27.

Foreign MDs help fill gaps, but hiring and clearance are big obstacles

07/10/2023

by: Roy Edroso

In medically underserved communities, doctors from overseas can help fill vacancies, particularly in needful areas such as primary care. But the current system only lets a small number of foreign doctors work in the U.S., and medical organizations that seek to employ them can count on long waits and red tape.

Hear me out: How to code bone conducting hearing devices in CPT

07/10/2023

by: Debbie Jones, CPC, CCA

Hearing loss affects millions of people worldwide, and conventional hearing aids have been the standard solution for decades. However, a surgical osseointegrated bone prosthesis has emerged as a popular alternative for patients who cannot adjust to traditional hearing aids. This type of hearing device bypasses the middle ear and treats hearing loss through a process called “osseointegration.”

OIG audit spots potential coding pitfalls for psychotherapy services

07/10/2023

by: Savannah Schmidt

The Office of Inspector General (OIG) recently released the results of an audit of Medicare billing requirements for psychotherapy services submitted from March 2020 through February 2021 as providers adapted to changes introduced as a result of the COVID-19 public health emergency (PHE).

Practices turned to telehealth for 40% of psych visits after CMS waivers

07/10/2023

by: Richard Scott

Auditors are keying in on psychotherapy services delivered via telehealth, and Medicare claims show that they will have a massive trove of data to investigate. In 2021, as the COVID crisis continued to shutter offices, providers routinely turned to telehealth to deliver behavioral health care to patients after CMS granted waivers, capturing some 40% of visits on the most-used services.

Language translation apps may leave you open to liability; use wisely

07/03/2023

by: Roy Edroso

Are you using, or thinking about using, a translation app to fulfill your responsibilities to patients who are not fluent in English? You may have seen or heard about the ease with which available apps can translate conversation on the fly and wondered whether that would work for the office as well.

Know what to do when a prescribed device is subject of FDA warning letter

07/03/2023

by: Julia Kyles, CPC

The Food & Drug Administration (FDA) recently issued a warning letter to iRhythm Technologies about the Zio AT, one of the manufacturer’s mobile cardiac monitoring devices. However, an FDA warning letter is cause for alertness, not alarm, on the part of providers.

ICD-10-CM update ushers in critical changes to tabular addenda

07/03/2023

Take note of hundreds of updates to the tabular addenda that serves as an instruction guide to the ICD-10-CM code set (PBN 6/26/23). CMS announced the changes as part of the code set update on June 16. All changes, including new, revised and deleted codes and the tabular addenda revisions, take effect Oct. 1.

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