Part B News | Part B News

CMS unveils inflation drug pricing changes, with a Part B wrinkle coming soon

02/27/2023

A flurry of drug-pricing activity at HHS and CMS shows the agencies looking forward to big changes in what they’ll pay pharmaceutical companies for Medicare drugs. Most of these won’t affect providers and patients directly for some time — except for one shift that will appear as early as April 1 for some practices that dispense Part B drugs.

E/M update includes review warning for time, no help for split/shared billing

02/27/2023

by: Julia Kyles, CPC

You’ll find Medicare’s new and revised rules for hospital visits, nursing facility visits, prolonged services and split/shared visits in CMS 100-04, Change Request 13064, released February 9. The update includes more information on documenting time-based visits but is silent on component-based split/shared billing.

Implant 2023 CPT code changes for integumentary procedures

02/27/2023

by: Savannah Schmidt

The AMA update to the 2023 CPT code set has brought three code additions, one revision and one deletion to the integumentary chapter. Ensure your staff is aware of the changes, effective Jan. 1, to avoid claims disruptions.

Top screenings remained suppressed, down 3%, after 2020 tumult

02/27/2023

by: Richard Scott

The most-billed health screenings covered under Medicare took a big dip in 2020 as the pandemic wrought a utilization depression, and, though some screenings are starting to come back, most of them hadn’t fully recovered a year later.

Private payer updates highlight the two sets of E/M policies

02/20/2023

by: Julia Kyles, CPC

Keep one eye on your private payers’ policies for E/M and prolonged services, the other on your denials and make sure you have a firm understanding of the differences between the AMA’s CPT guidelines and CMS rules for the services. You can reduce denials and improper payments if you understand where AMA and Medicare don’t see eye-to-eye on E/M coding.

TMA beats CMS again on No Surprises; new rule expected

02/20/2023

by: Roy Edroso

The Texas Medical Association (TMA) won a court case against HHS and other agencies in February 2022, forcing them to make adjustments to their No Surprises Act rules. Now a federal judge has ruled that the Departments didn’t go far enough with the change, sending them back to the drawing board.

Tackle remote therapeutic monitoring coding and CPT changes for 2023

02/20/2023

by: Debbie Jones, CPC, CCA

You have more options to provide virtual services in 2023 with new platforms and ways to report them. Embrace the role of remote therapeutic monitoring (RTM), one of the latest services to enter the virtual landscape.

AI in health care heats up, but clinical concerns keep it at a low boil

02/20/2023

by: Roy Edroso

The heightened interest in artificial intelligence (AI) tools such as ChatGPT is a reminder that AI also has a place in health care even at the practice level, as a patient communication tool and in clinical decision support. Its computing power is quickly increasing; however, so far its old drawbacks remain in place.

Telephone E/M visit claims declined despite waivers, higher pay

02/20/2023

by: Julia Kyles, CPC

Practices dialed back their use telephone E/M services (99441-99443) for Medicare Part B patients in 2021. However, the time-based codes remained popular with primary care providers.

The end of the PHE is coming: Watch for EUAs, brace for hospital, Medicaid pain

02/13/2023

by: Roy Edroso

Some of the issues raised by the recent surprise announcement of the end of the COVID-19 public health emergency (PHE) — slated to draw to a close on May 11 — have been headed off by government action. For example, Medicare telehealth flexibilities will remain in place through 2024. But if federal and state authorities don’t act before May 11, some providers could still lose income streams as well as manpower.

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