Part B News | Part B News

MedPAC recommends inflation-adjusted physician payment, add-on fees

04/03/2023

The latest MedPAC report to Congress, released March 15, includes a proposal to boost physicians' 2024 Medicare payments based on the Medicare Economic Index (MEI). This has intrigued industry groups, although they aren’t satisfied with the numbers. The Medicare watchdog also suggests standing bonuses for some care delivered to poorer patients and reiterates its concerns about Medicare Advantage.

Refresh the basics of anti-kickback statute compliance

04/03/2023

by: DecisionHealth Staff

Certain aspects of the anti-kickback statute (AKS) and the Stark law were subject to COVID-19 public health emergency (PHE) waivers. These flexibilities are set to expire with the end of the PHE on May 11. After that date, organizations must comply with these laws as they did prior to the issuing of the PHE waivers in March 2020.

Denials quadrupled after hospital outpatient prior-auth policy took hold

04/03/2023

by: Julia Kyles, CPC

Denials spiked for a variety of services performed in the hospital outpatient setting even as utilization tumbled, and a Medicare prior authorization policy may be one reason behind the change.

New math for prolonged hospital visits could equal revenue surge for practices

03/27/2023

by: Julia Kyles, CPC

Check your practice’s highest-level inpatient and observation E/M visit claims (99223, 99233 and 99236). Medicare’s revised threshold times for add-on code G0316 (Prolonged inpatient or observation services by physician or other QHP) may have opened the door to more revenue for hospital visits that are coded based on time.

Time change: Revised prolonged service threshold chart

03/27/2023

by: Julia Kyles, CPC

Use this updated threshold chart for prolonged E/M services associated with same-day, face-to-face visits performed by physicians and qualified health care professionals (QHP). Medicare has revised the threshold times for prolonged service code G0316, effective Jan. 1.

First inflation-rebate drug prices hit April 1 in rollout of CMS drug policy

03/27/2023

by: Roy Edroso

CMS has rolled out its first wave of Part B and Part D drug policy innovations, and medical groups and some patients and providers will feel some effects — specifically lower co-insurance for Medicare beneficiaries on 27 drugs, effective April 1 — pretty quickly. Others will take time to kick in.

No Surprises IDR freeze ends; new guidance may (or may not) sway litigants

03/27/2023

by: Roy Edroso

A month after a second court loss on its No Surprises Act (NSA) independent dispute resolution (IDR) process that led to a temporary freeze, HHS has restarted the IDRs and issued new guidance — though there’s no guarantee the litigants who beat them will be satisfied.

Pick up the tab: Review proposed changes to the ICD-10-CM tabular section

03/27/2023

by: Julia Kyles, CPC

Review proposed changes to ICD-10-CM tabular section that are slated to go into effect Oct. 1 while you wait for the proposed changes to the code set that Medicare will release in the FY2024 hospital inpatient prospective payment system (IPPS) proposed rule.

Ensure compliance with added, deleted digestive system codes

03/27/2023

by: Savannah Schmidt

Have your coding and procedure updates for the digestive system go down easy by understanding the nuances of the changes within the 2023 CPT code set. You’ll find more than a dozen deleted codes and new codes to replace them, as well as fresh code-bundling guidance.

Some drugs with co-insurance cuts have low usage, high denials

03/27/2023

by: Roy Edroso

The lowered co-insurance rates on some average sales price (ASP) drugs in the 2nd quarter of 2023 is good news for some Part B drug users. But these modest cuts still represent only a small percentage of Medicare’s enormous drug tab.

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