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Stay in place: Payer place of service errors spark observation claim denials

02/13/2023

If you experienced a recent surge of denials for observation visits, a payer error could be to blame. Four Medicare administrative contractors (MAC) have announced that they improperly denied claims for hospital inpatient and observation care codes and are working on the problem. The error affects claims for observation visits performed on or after Jan. 1 and is triggered by the place of service (POS) on the claim.

Are you up to date? COVID-era relief programs issue warnings

02/13/2023

by: Roy Edroso

A note from a Medicare administrative contractor (MAC) serves as a reminder that some federal programs in which you enrolled are still expecting payment or attestations, and if you aren’t aware of that you’re still liable.

Expect HIPAA compliance to wind up when the PHE winds down

02/13/2023

by: Julia Kyles, CPC

Hope for the best, prepare for the worst and don’t be surprised by anything in between while you prepare for the return of HIPAA rules for telehealth services.

Be careful about upcoding; DOJ may come after it as a false claim

02/13/2023

by: Roy Edroso

Question: I recently saw a Department of Justice settlement in North Carolina that seemed to be entirely based on a pattern of upcoding E/M. I didn’t know federal prosecutors did that! Is it common?

Monthly care management grew in 2021 – but with one surprise

02/13/2023

by: Roy Edroso

In the second pandemic year of 2021, care management codes, including complex and psychiatric collaborative codes, and principal care codes continued to creep up despite the general Medicare utilization downturn. However, in a significant reversal, the original CCM code 99490, the biggest biller of them all, turned negative.

CMS wants total ACO Medicare by 2030. Experts aren’t so sure.

02/06/2023

by: Roy Edroso

CMS is touting the growth of three accountable care organization (ACO) programs — and predicts it will meet its goal of connecting all Medicare beneficiaries to ACOs by 2030. Experts aren’t so sure, though they do think Medicare’s ACO program is heading in the right direction.

COVID public health emergency to end May 11

02/06/2023

by: Roy Edroso

The Biden administration announced its intention to end the U.S. COVID-19 public health emergency (PHE) on May 11, 2023. In place since Jan. 31, 2020, the PHE has allowed numerous flexibilities within the Medicare program that will need to be either extended or wound down.

Part II: Follow AMA policymakers’ advice to succeed in hospital coding retool

02/06/2023

by: Julia Kyles, CPC

Find additional guidance on admission and discharge coding, the importance of social determinants of health (SDOH) and using time to report services.

Alert staff that PHI must stay secure, even when it’s of a family member

02/06/2023

by: Julia Kyles, CPC

Highlight the importance of an impenetrable work/life firewall when staff have access to the protected health information (PHI) of relatives, friends and other acquaintances. They can access the PHI when they stick to the rules. But if you ignore access rules, you risk exposing the practice to a HIPAA breach.

AMA unveils 22 new T codes for heart, joint procedures

02/06/2023

by: Laura Evans, CPC

Starting July 1, practices will have a diverse collection of new CPT Category III codes to use for procedures including pulmonary artery denervation, two-chamber leadless pacemaker implant and percutaneous sacroiliac joint fusion.

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