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New CPT guidelines clarify same-day services in the facility setting

10/23/2023

Your 2024 CPT contains manual contains revised guidelines for multiple same-day E/M visits in the hospital or nursing facility settings, when performed by the same physician or qualified health care professional (QHP). But the update serves as a reminder that there are areas where the CPT manual and CMS rules don’t match up.

OIG audit another hint that feds are scoping MA claims

10/23/2023

by: Roy Edroso

A recent report on overpayments attributable to faulty Medicare Advantage (MA) coding is just the latest in a series of signs that HHS is paying closer attention to those claims. Although it’s the Medicare Advantage organizations (MAO) that are in the direct line of fire, providers may sustain some collateral damage.

Know time rules, medical necessity when reporting critical care services

10/23/2023

by: Jessica Miller-Dobbs, CPC, CPC-P, CGIC

Critical care coding is one of the most detailed specialties and can challenge both new and seasoned coders. The intricate details of the documentation take many coders by surprise and can be a challenge. To report critical care, coders need to understand the definition.

UHC HIPAA breach signals call to action for compliance departments

10/23/2023

by: Dom Nicastro

Heed a recent settlement between the Office for Civil Rights (OCR) and UnitedHealthcare (UHC). Experts say it serves as a stark reminder of the importance of HIPAA compliance and the right of patients to access their medical records in a timely manner.

First year of split or shared modifier reveals leaders in team care

10/23/2023

by: Julia Kyles, CPC

Emergency medicine providers are the top team players, according to analysis of Medicare data for modifier FS (Split [or shared] evaluation and management visit).

CY2024 CPT update delivers 230 new codes, fine tunes E/M times

10/16/2023

by: DecisionHealth staff

Take a glimpse at the hundreds of CPT coding updates coming in 2024 to prepare your coding and billing staff for a successful turn of the calendar. You’ll find new codes, as well as code revisions, spread throughout the updated CPT manual, in addition to important guideline changes.

Shutdown threat, PFS patches loom for end-of-year Congress

10/16/2023

by: Roy Edroso

With the House of Representatives in flux, it looks as if the threat of a shutdown — and its potential impact on CMS operations, including distribution of medical payments — has become a live issue.

Check your Medicare telehealth compliance against HIPAA, DEA rules

10/16/2023

by: Julia Kyles, CPC

Many of the popular telehealth waivers that Medicare created during the COVID-19 public health emergency will stay in place until Dec. 31, 2024. But when you provide telehealth to Medicare patients, make sure you also follow the HHS Office for Civil Rights’ (OCR) and the Drug Enforcement Administration’s (DEA) rules that apply to all telehealth services.

Waive co-pay for indigent patients on urgent basis, but be clear it’s not forever

10/16/2023

by: Roy Edroso

Question: Our practice waived a co-pay for an insured patient in a financial hardship case last year. Our reasoning was that the patient needed care urgently and we weren’t comfortable turning them away. The patient has scheduled another visit, however, and we anticipate that the matter will be less urgent and we plan to require a co-pay before treatment. Could the patient refuse and charge patient abandonment on the grounds that we accepted their hardship earlier?

For new integrated services, community helpers do not qualify as official workers

10/16/2023

by: Julia Kyles, CPC

Question: Please provide more information about the community health integration (CHI) service in the proposed 2024 Medicare physician fee schedule... If a Medicare patient can’t drive to their doctor’s appointments, pick up their prescriptions or perform other tasks related to receiving health care, can a treating provider count the services of community helpers who perform those tasks toward CHI? In other words, can drivers and delivery people be auxiliary personnel, as described in the proposed rule?

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