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New ACA rule makes keeping coverage easier for beneficiaries

05/01/2023

If you have patients with Affordable Care Act (ACA) marketplace plans, changes announced in the HHS/CMS Notice of Benefit and Payment Parameters for 2024, released April 17, are likely to make it easier for them to remain in the program. Also, heads up: Though HHS has delayed it, in 2025 plans can be penalized for missing certain access-to-care targets, which may affect how those plans add providers to their networks.

Make sure time is on your side for discharge day documentation

05/01/2023

by: Julia Kyles, CPC

Train your providers to capture the time for all discharge day management visits. If they stick to the strictest standard, you won’t have to wonder if your claims will meet a specific payer’s policy.

Latest Category III codes address shoulder, spine, cartilage injuries

05/01/2023

by: Laura Evans, CPC

Among the batch of CPT Category III codes that took effect Jan. 1, 2023, practices will find two codes for cutting-edge regenerative musculoskeletal procedures, one for use of animal implants and a code for facet joint replacement at a single vertebral level.

OIG issues audit guidelines for telehealth risk

05/01/2023

by: Roy Edroso

On April 24, OIG released a toolkit for “Analyzing Telehealth Claims to Assess Program Integrity Risks.” The toolkit is based on investigations during the first year of the pandemic which revealed, OIG says, “Medicare beneficiaries used 88 times more telehealth services” than they did previously.

Consider this rule of thumb when selecting MDM complexity for fracture care

05/01/2023

by: Laura Evans, CPC

Question: If a patient has a fractured femur and ankle would this be considered high complexity when coding based on medical decision-making? Just looking for more clarification on what the AMA’s E/M guidelines consider “poses a threat to life or bodily function.”

X marks the spot: XS, XU modifiers outclass 59 in denial rate battle

05/01/2023

by: Richard Scott

In a head-to-head showdown, the series of X modifiers that CMS permits for two or more procedures on the same date of service turned in favorable performances compared to modifier 59 (Distinct procedural service), even as total X-modifier claims came in low.

As PHE nears end, know when audio-only care becomes ePHI — and stay compliant

04/24/2023

by: Julia Kyles, CPC

HIPAA compliance for telehealth services applies to audio-only services, including telephone E/M codes (99441-99443). To protect your practice and patients from breaches, make sure staff understand the security requirements for phone-based care that the HHS Office for Civil Rights (OCR) outlined in a guide on audio-only services.

For providers: An at-a-glance guide for PHE end on May 11

04/24/2023

by: Julia Kyles, CPC

Help your busy providers prepare for the end of the COVID-19 public health emergency (PHE) with this summary of key waiver activities that will and will not be allowed after May 11. For example, providers can continue to perform telephone E/M services after May 11, but they cannot perform virtual check-ins for new patients.

Examine documentation improvement strategies for 2023 CPT updates

04/24/2023

by: Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

The January 2023 update to the CPT manual introduced 225 new and 93 revised codes, while 75 codes were deleted, with almost every chapter undergoing some form of change. As expected, the spotlight fell on facility-based E/M services, with changes to codes, descriptions, guidelines, definitions and the medical decision-making (MDM) table.

When drugs are partially discarded: Clarify use of modifier JW

04/24/2023

by: Savannah Schmidt

Modifier JW (Drug amount discarded/not administered to any patient) is used to describe drug amounts that are discarded and not administered to any patient. It does not reduce the payment for the drugs so it is an informational modifier; however, but you’re required to use it on Medicare claims for drug wastage. Wrap in the following guidance and tips to ensure your claims are accurate.

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