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Providers must specify the risk for decision regarding surgery

06/26/2023

All procedures come with inherent risks, but you can’t automatically count those risks toward medical decision-making (MDM) for an E/M visit. The treating provider must identify the specific risk of a minor surgery or a major elective surgery.

Want a J-1 visa doctor? Prepare to work (and pay) for it

06/26/2023

by: Roy Edroso

Question: We’re in a HPSA [health professional shortage area] and have trouble finding appropriate doctors. I’m told there’s a government program that allows qualified foreign doctors who want to work in the U.S. to do so if they commit to working in a HPSA. How do we get in on that?

QPP report shows MIPS sagging, Advanced APMs lifting

06/26/2023

by: Roy Edroso

The latest Quality Payment Program (QPP) Experience Report, released on June 12, showed the number of eligible providers in MIPS declined, though Advanced APM participants rose. And as usual nearly everyone escaped a penalty, though bonuses remain low.

The Medical Practice Guide to Telehealth and Remote Patient Monitoring

06/26/2023

by: DecisionHealth Staff

CMS and other federal agencies have opened up telehealth coverage policies during the COVID-19 public health emergency (PHE), while a series of virtual care options have come online in recent months.

Look out for latest NCCI update featuring 531 new edit pairs

06/19/2023

by: Julia Kyles, CPC

CMS issued a modest set of procedure-to-procedure (PTP) and medically unlikely edits (MUE) in the latest quarterly update to the National Correct Coding Initiative (NCCI) edits. The edits take effect July 1.

Not just for Pride: LGBTQ outreach improves care, builds patient population

06/19/2023

by: Roy Edroso

You may notice an increase in awareness of LGBTQ issues in June, aka Pride month, including issues impacting health care. Experts cite a variety of reasons, ranging from the ethical to the financial, why practices should make sure they’re taking extra steps to welcome patients from the LGBTQ community — and not just for a month.

Avoid auditing misconceptions with these 3 reminders

06/19/2023

by: HCPro staff

Audits can be the source of irritation in small and large practices alike. These necessary evils are often headaches for coders — but they don't have to be. To create a smooth auditing process, consider common misconceptions about the auditing process and discover tips from experts on how to correct them.

Top codes with modifier 25: ED, eye exams, critical care stand out

06/19/2023

by: Richard Scott

Look to emergency department visits, eye exams and critical care services if you’re running an assessment of claims involving the sometimes-tricky rules for modifier 25 (Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of the procedure or other service). Outside of office visits, those services topped the list of most-used code combinations with the same-day E/M modifier.

Doing telehealth from home? If you’re zoned out, take steps to fix it

06/12/2023

by: Roy Edroso

Because of an expected new enrollment requirement, providers doing “telehealth from home” (TFH) may want to check their local zoning ordinances before setting up shop.

Capture correct level of risk for Rx management, parenteral controlled substances

06/12/2023

by: Julia Kyles, CPC

Help your team assign the risk of complications and/or morbidity or mortality of patient management based on prescription (Rx) drug management or parenteral controlled substances when you report E/M services.

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