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Proposed HIPAA rule would protect PHI related to reproductive health care

05/08/2023

Prepare to update your HIPAA compliance plan. A proposed rule issued by the HHS Office for Civil Rights (OCR) on April 12 would require stronger guards on protected health information (PHI) related to reproductive health care.

OCR seeks public input on reproductive health definition

05/08/2023

by: Julia Kyles, CPC

The HHS Office for Civil Rights (OCR) intends to create a specific definition for reproductive health to clarify the types of protected health information (PHI) that are covered by the proposed update to the privacy rule..

Modifier 25 decision tree can prevent denials, claims errors

05/08/2023

by: Julia Kyles, CPC

Use this decision tree to improve your staff’s accuracy when turning to modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

Find expert tips to dodge real-time CPT coding and billing errors

05/08/2023

by: Thea Sinclair

Thea Sinclair, content writer at Medcare MSO, provides a roadmap for avoiding common coding and billing snafus that can lead to revenue loss.

Total ABN modifier use up in 2021, but three of four fell hard

05/08/2023

by: Roy Edroso

Practices’ use of the four modifiers related to advance beneficiary notices of non-coverage (ABN) was steady overall between 2020 and 2021. But gains and losses in 2021 were differently distributed than they had been the previous year, with three modifiers taking a nosedive.

Create a plan to defend modifier 25 claims ahead of new Cigna policy

05/01/2023

by: Julia Kyles, CPC

Your practice should stand firm on compliance and reimbursement when it submits E/M claims with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).

New ACA rule makes keeping coverage easier for beneficiaries

05/01/2023

by: Roy Edroso

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.

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