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Groups call on CMS to avert 2021 payment cuts, but does CMS have the authority?

10/19/2020

The deadline to submit comments to CMS for the proposed 2021 Medicare physician fee schedule (PFS) passed on Oct. 5 and, judging by a preliminary look at the feedback, the federal agency is facing a number of difficult policy decisions. Perhaps most vexing is what to do about proposed revisions to schedule-wide pay rates that would have a substantial impact on practice revenue next year.

MDPP can help patients, but earnings are unlikely the reason to offer it

10/19/2020

by: Roy Edroso

Two years in as a billable service, the Medicare Diabetes Prevention Program (MDPP) has not achieved great penetration and does not promise large financial benefits for participating suppliers. But the benefit of care for patients is reported to be substantial, and under some payment models you may find the program worth offering.

The latest Correct Coding Initiative edits may have you seeing double

10/19/2020

by: Julia Kyles, CPC

Question: The latest version of procedure-to-procedure (PTP) edits contains hundreds of duplicate edit pairs. The only difference between the pairs is that the first is deleted and the second is valid. This is an example of what we’re seeing... The deletion date is always 12/31/2019. Is this a mistake or is there a reason some pairs look this way?

How to bill during the PHE when doctor calls patient with MRI results

10/19/2020

by: Laura Evans, CPC

Question: Now that our joint surgeons are gearing back up to again perform elective procedures, if the surgeon sees the patient in the office and schedules an MRI for them, can we bill for a telehealth visit afterward to go over the results so the patient does not need to return to the office? Is there a particular telehealth code to report if the doctor calls them with the test results?

Medicare’s diabetes prevention program yet to hook many practices

10/19/2020

by: Richard Scott

Providers have been slow to make an entrance into the Medicare Diabetes Prevention Program (MDPP), which offers a series of payments to fight the rising rates of type 2 diabetes.

Update your HIPAA training to reflect emerging practice trends

10/15/2020

by: Marla Durben Hirsch

Review your practice’s HIPAA training. It may be outdated if it hasn’t evolved with business operations, technology and government priorities.

Medicare Advantage growth continues, but tread carefully if you’re new to the contracts

10/12/2020

by: Roy Edroso

Medicare Advantage plans are a hotter prospect than ever for beneficiaries — but maybe not so much for providers. If you want to get involved in those contracts, keep your eyes open and watch the fine print.

CMS finalizes mandatory radiation oncology model launching in 2021

10/12/2020

by: Valerie Rinkle, MPA, CHRI

On Sept. 18, the Centers for Medicare and Medicaid Innovation (CMMI) published the final Radiation Oncology Model (ROM) rule. This demonstration project is a mandatory model that includes approximately 30% of outpatient radiation therapy episodes nationally furnished by freestanding and hospital-based radiation oncology providers.

When a doctor dies, mind patient records and act fast if heirs are unlicensed

10/12/2020

by: Roy Edroso

Question: If one of our physicians dies, what are we obliged to do besides notify the patients and invite them to transfer care to one of our other doctors?

How to report shared visit services using the 2021 E/M guidelines

10/12/2020

by: Sarah Gould

Question: During an office visit, a nurse reviews the patient’s medical history and a physician performs an examination in the presence of the nurse. If you adhere to the 2021 E/M guidelines and use time as the controlling factor for code selection, can you report one E/M code for these shared services?

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