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If SCOTUS kills ACA, prepare for uninsured patients till states, Congress act

10/26/2020

The Supreme Court is again weighing the fate of the Affordable Care Act (ACA) in California v. Texas, and the odds on its repeal seem higher than ever. Some experts think the ACA still has a good chance of surviving. But if all or part of it falls, even many of your non-exchange patients will have to rely on lawmakers to pick up the slack.

Audio-only services, E/M documentation updates major focus of PFS comments

10/26/2020

by: Richard Scott

Various stakeholders are calling on CMS to maintain the current payment rates for audio-only E/M services after the COVID-19 public health emergency (PHE) ends, and others want to see a permanent removal of telehealth restrictions.

E/M and stress tests: When to report a separately payable service with modifier 25

10/26/2020

by: Sarah Gould

Question: A patient with a history of hypertension and high cholesterol visits a cardiologist for an appointment, complaining of occasional chest discomfort during exercise. After the physician completes an office visit, it is determined that the patient needs a cardiovascular stress test, which is performed that day by the same physician. Would it be appropriate to report an E/M code for the visit with modifier 25 (Significant, separately identifiable E/M)?

Modifier 25 does well with E/M codes — and sometimes others

10/26/2020

by: Roy Edroso

Providers seem to vastly favor using modifier 25 (Significant, separately identifiable E/M service) in mid-level established patient visits over any other. But it gets a workout with other codes as well – some of them inappropriately.

Welcome third round of HHS relief funds, eased lending terms for accelerated payments

10/22/2020

by: Roy Edroso

If you took advantage of CMS’ Accelerated and Advance Payment Program, CMS has good news for your repayment responsibilities. And if you also took advantage of the CARES Act Provider Relief program, HHS has good news there as well.

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