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MAC demand: Medical necessity controls coverage of preop E/M visits
04/15/2024
by: Julia Kyles, CPC
Pay close attention to medical necessity when a provider schedules a patient for a preoperative visit and you code the E/M visit. Even though a hospital may require preoperative clearance for surgery patients, Medicare controls whether it will pay for the visits. Surgeons may have more leeway than specialists when they perform certain preoperative visits, but they must still support medical necessity to protect their patients from an unexpected bill and the practice from unexpected denials.
Medicare Advantage rate rise miffs payers; blowback should be minor
04/15/2024
by: Roy Edroso
On April 2, CMS approved a final average 3.7% increase on the Medicare Advantage base rate for 2025, an adjustment Medicare Advantage organizations (MAO) and the insurers who run them found disappointing. While some advocates have suggested these plans will pull back on benefits, large changes are not expected in the short run.
HIPAA Q&A: Watch cybersecurity frameworks, health apps, texts
04/15/2024
by: Dom Nicastro
In this week’s issue, Rebecca Herold, CDPSE, FIP, CISSP, CIPM, CIPP/US, CIPT, CISM, CISA, FLMI, HIPAA security and privacy training expert and CEO of Privacy & Security Brainiacs SaaS services, answers a range of questions about cybersecurity efforts, HIPAA compliance in health apps and much more.
FFS Medicare fades, as Medicare Advantage surges in enrollment
04/15/2024
by: Roy Edroso
The most recent CMS numbers show Medicare Advantage enrollment continuing to outpace traditional Medicare, and some measures suggest Part C has already beat fee-for-service Medicare to become the majority Medicare insurer.
Time out: Encourage compliance with a stay of enrollment review
04/08/2024
by: Julia Kyles, CPC
Use Medicare’s new “stay of enrollment” rule to warn your staff: CMS’ easier option for non-compliance is still hard on the practice’s finances.
CMS’ loans for Change Healthcare hack may not be worth it: Expert
04/08/2024
by: Roy Edroso
Both CMS and UnitedHealth Group (UHG) have offered cash loans to practices impacted by the recent Change Healthcare hack. But an industry expert cautions that the CMS package might not be your best course of action.
CMS update: Code caregiver training services based on number of patients
04/08/2024
by: Julia Kyles, CPC
Update your staff with the latest information about caregiver training services (CTS) from CMS. A set of frequently asked questions on health-related social needs answers some lingering questions about the CTS for behavior management/modification (96202-96203) and functional performance (97550-97552). 
Know full descriptors for caregiver training services
04/08/2024
by: Julia Kyles, CPC
Use the latest guidance from CMS to correctly code caregiver training services. Here are the full descriptors that shed light on your coding and billing designs.
Patient assault underlines need for tight office entry restrictions
04/08/2024
by: Roy Edroso
A recent attack by a man who conned his way into a chiropractor’s office is a reminder to ensure basic security is followed in all cases — and that more than basic security is likely worth the investment.
HCPCS 2024 first quarter update brought nearly 100 changes
04/08/2024
by: Savannah Schmidt
CMS published its HCPCS quarterly update in March, which heralded the sum of 94 HCPCS Level II code additions, discontinuations and definition revisions. 
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